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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604128
Report Date: 02/03/2025
Date Signed: 02/03/2025 12:27:51 PM

Document Has Been Signed on 02/03/2025 12:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MOUNTAIN SHADOWS THERAPEUTIC DAY PROGRAMFACILITY NUMBER:
374604128
ADMINISTRATOR/
DIRECTOR:		HEARD, DONNAFACILITY TYPE:
775
ADDRESS:970 LOS VALLECITOS BLVD #130TELEPHONE:
(760) 743-3714
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 50CENSUS: 6DATE:
02/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Administrator, Heathcliffe MooreTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On 2/3/2025, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility to conduct a required annual inspection. LPA met with Administrator, Heathcliffe Moore who was informed of the purpose of the visit. The facility has a fire clearance for 25 ambulatory and 25 non-ambulatory adult clients and is approved for delayed egress. During the visit, there was six (6) clients and 12 care staff present.

LPA toured the facility's interior and exterior with Administrator Moore. The facility has several areas designated for activities including arts and crafts, exercise, gardening along with a sensory room, computer lab, isolation room, lounging room called the Cat Cafe, and two (2) multipurpose rooms available for client use. Staff present have a criminal record clearance and are associated with the facility. During the visit, the facility met the staff-to-client ratios specified by the clients' care plans. LPA toured the kitchen and observed the kitchen area to be clean. Snacks are stored in a safe and healthful manner and provided to clients during program hours. Restrooms were clean and had toilet paper, paper towels and soap readily available for the clients. Cleaning solutions and disinfectants were secured in a locked storage closet. Client medication is secured in a locked medication cabinet stored near the Cat Cafe. The facility’s last fire drill was conducted on 1/8/2025. Facility staff tested the smoke alarms and LPA observed staff help clients identify their nearest emergency exit and everyone promptly evacuated the building. Administrator Moore tested the delayed egress and LPA observed it to be operational. Facility staff also tested the carbon monoxide detectors and LPA observed them to be operational. LPA observed two (2) charged fire extinguishers, which were last serviced on 12/3/2024. During today’s visit, LPA did not observe any issues or concerns. An exit interview was conducted and this report was reviewed and provided to Administrator Moore.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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