<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360902944
Report Date: 01/08/2025
Date Signed: 01/08/2025 01:34:16 PM

Document Has Been Signed on 01/08/2025 01:34 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:INLAND CHRISTIAN HOME, INCFACILITY NUMBER:
360902944
ADMINISTRATOR/
DIRECTOR:		MARY WOLFFFACILITY TYPE:
741
ADDRESS:1950 SOUTH MOUNTAIN AVENUETELEPHONE:
(909) 983-0084
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 297CENSUS: 159DATE:
01/08/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH: Executive Daniel SteinstraTIME VISIT/
INSPECTION COMPLETED:
01:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. Executive Director David Steinstra met with LPA Hernandez and LPA explained the purpose of today's visit.

The facility is a residential care for the elderly (RCFE) Continuing Care Retirement Community (CCRC). The facility is licensed for a capacity of two hundred ninety-seven (297) Current census is one hundred-fifty nine (159). LPA Hernandez was accompanied by Memory Care and Assisted Living Director Denise Perez, Executive Director David Steinstra and Director of Operations Daryl Whitehead to conduct a general overall inspection, which included, but was not limited to, the following:

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature at 67 degrees. LPA Hernandez inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Hernandez observed sufficient furniture and lighting throughout the facility. LPA Hernandez observed the water temperatures in the bathroom to be at 111 degrees F. The facility is equipped with operating smoke and carbon monoxide detectors. Fire extinguishers were also observed at the facility. Posters such as personal rights, the CCL complaint poster, labor laws, and the disaster plan were posted in a common area. LPA observed scissors and knives to be kept unlocked accessible to residents in care. Deficiency will be issued. There was a designated storage space for resident/staff files. There is a Medicine Room with the resident’s medications locked.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: INLAND CHRISTIAN HOME, INC
FACILITY NUMBER: 360902944
VISIT DATE: 01/08/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Food Service: More than seven (7) days’ supply of Non-perishable foods and more than three (3) days supply of perishable food supply were observed and sufficient for the number of residents in care.

Care & Supervision: The facility has an Executive Director David Steinstra present in the facility with appropriate and enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care.

Record Review: LPA Hernandez reviewed fourteen (14) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA Hernandez reviewed five (5) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA Hernandez reviewed (6) resident's medications. No issues were observed.

Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC809), (LIC809C) and Appeal Rights were discussed and provided to Memory Care and Assisted Living Director Denise Perez.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2025
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/08/2025 01:34 PM - It Cannot Be Edited


Created By: Raquel Hernandez On 01/08/2025 at 12:55 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: INLAND CHRISTIAN HOME, INC
FACILITY NUMBER: 360902944

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/08/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)
Storage Space and Access
(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above by not ensuring scissors and knives were kept locked inacessible to residents in care, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/09/2025
Plan of Correction
1
2
3
4
Executive Director Danie Steinstral and Assisted Living Director Denise Perez removed scissors and knives and were put away inacessible to residents in care during visit. Plan of Correction will be cleared.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Efren Malagon
LICENSING EVALUATOR NAME:Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:
DATE: 01/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/08/2025


LIC809 (FAS) - (06/04)
Page: 3 of 3