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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880649
Report Date: 05/09/2024
Date Signed: 05/09/2024 02:56:34 PM

Document Has Been Signed on 05/09/2024 02:56 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:CASA BIENFACILITY NUMBER:
361880649
ADMINISTRATOR/
DIRECTOR:
TANDOC, JR. BIENVENIDAFACILITY TYPE:
740
ADDRESS:620 RYAN STTELEPHONE:
(909) 253-1911
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY: 6CENSUS: 5DATE:
05/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Bienvenida Tandoc Jr - AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Magda Malcore conducted a follow-up visit in relation to Redlands Fire Department inspection results submitted to the Regional office on 5/06/24. LPA Malcore met with Bienvenida Tandoc Jr, Administrator, and discussed the purpose of the visit.

On 5/01/2024, the Redlands Fire Department conducted an inspection due to a change of Ambulatory status submitted by the facility. The facility currently has an approved fire clearance for 6 ambulatory and the facility requested a fire clearance for 6 nonambulatory status. Based on Redlands Fire Department inspection report, structural changes would need to be made before a change of ambulatory status maybe cleared by the Fire Department.

The Administrator stated that on 5/06/24, she consulted an contractor to have french doors with direct access to the backyard constructed in bedroom #1 and bedroom #2. The Administrator stated that bedroom #1 and bedroom #2 will be shared rooms. Bedrooms #3 and #4 will remain ambulatory. The Administrator stated she will have an updated medical assessment for resident #1 (R1) to confirm their ambulatory status as the report on file is dated 10/11/2019, prior to a possible eviction.

The Administrator was advised all construction documentation and status shall be submitted to the licensing within a timely manner.

An exit interview was conducted where this report was discussed and copy of this report was provided to the Administrator at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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