366401835-10-24-2023-56-AS-MMAE-CWX4PJ-20231024191645

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 366401835
Report Date: 09/07/2023
Date Signed: 10/24/2023 07:18:16 PM

Document Has Been Signed on 10/24/2023 07:18 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	CEDAR WAY HOME		FACILITY NUMBER:	366401835
ADMINISTRATOR:	SENGKE, KENNY\		FACILITY TYPE:	735
ADDRESS:	11589 CEDAR WAY		TELEPHONE:	(909) 894-4602
CITY:	LOMA LINDA	STATE: CA	ZIP CODE:	92354
CAPACITY:	6	CENSUS: 4	DATE:	09/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Kenny Sengke, Administrator		TIME COMPLETED:	01:30 PM

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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced required 1-year visit to the facility. LPA met with Kenny Sengke, Administrator and discussed the purpose of the visit.

The facility is an Adult Residential Facility (ARF), license capacity of (6) with a current census of (4). LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

LPA inspected the facility inside and out. Facility backyard is fenced with self-latching gates. Facility has no outdoor bodies of water. Facility living room, dining room, family room and outdoor patio furniture are in good repair and sufficient for clients in care. The facility has sufficient lighting and is maintained at a comfortable temperature.

LPA inspected the kitchen. Hot water temperature tested at 105 degrees F. Facility has sufficient non-perishable and perishable food for number of clients in care. Facility food is stored in a safe and healthful manner. Facility has sufficient cups, plates, and utensils for client use.

LPA inspected client bedrooms. Bedrooms are equipped with beds, bed linen nightstands, chairs, storage space and sufficient lighting.

LPA inspected client bathrooms. Bathrooms are equipped with grab rails and slip mats. Hot water temperatures tested between 106 and 117 degrees F.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CEDAR WAY HOME	FACILITY NUMBER: 366401835
	VISIT DATE: 09/07/2023

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The facility is equipped with operating carbon monoxide alarms. Facility has posted in a common area the facility sketch, personal rights, disaster plan and emergency numbers. Facility has working telephone service on the premises and a properly screened fireplace. Facility has a complete first aid kit and extra first aid supplies. Facility has a sufficient supply of linen, towels, and hygiene products for clients in care. Sharps, disinfectants, and chemicals are kept locked and inaccessible to clients.

LPA inspected client medications. Medications are labeled and administered as prescribed. Medications are kept locked and inaccessible to clients in care.

LPA reviewed client files for admission agreements, Individual Program Plans (IPPs), physician reports and record of client safeguarded resources.

LPA reviewed staff files for criminal record clearances, first aid certifications, training, and health screenings.

An exit interview was conducted, where this report was discussed and a copy with appeal rights was provided to the Administrator at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 09/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/07/2023

LIC809 (FAS) - (06/04)

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