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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530075
Report Date: 01/15/2025
Date Signed: 01/15/2025 01:01:02 PM

Document Has Been Signed on 01/15/2025 01:01 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:CANYON VIEW COUNTRY HOMEFACILITY NUMBER:
365530075
ADMINISTRATOR/
DIRECTOR:		CREIGHTON, IRENFACILITY TYPE:
740
ADDRESS:418 HASTINGS ST.TELEPHONE:
(909) 548-1769
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY: 6CENSUS: 6DATE:
01/15/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:41 AM
MET WITH:Irene Creighton-Administrator TIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Iren Creighton, Administrator, and discussed the purpose of the visit.

The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (6) and a current census of (6) residents in care. The facility has a hospice waiver for (6) residents. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

Physical Plant: The facility has sufficient lighting and is maintained at a comfortable temperature. Resident’s bathrooms were operating in safe and sanitary conditions. The hot water temperature in residents' bathrooms measured 105 to 120 degrees F. Resident’s bedrooms have sufficient lighting and furniture appeared to be in good repair. Facility has operating carbon monoxide detectors, and telephone service. The facility has sufficient linen, towels, and personal hygiene items for residents. The facility has posted in a common area, Community Care Licensing complaint poster, Ombudsman poster, resident's personal rights, disaster evacuation plan and emergency telephone numbers.

The Indoor and outdoor passageways are free of obstruction. The facility has no bodies of water accessible to residents in care. Outdoor backyard is sufficient for resident activities and is enclosed with self-latching gates

Care & Supervision: Facility has (24) hour/(7) days a week care staff. Staff working have criminal record clearances or exemptions through the Department.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE: DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/15/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: CANYON VIEW COUNTRY HOME
FACILITY NUMBER: 365530075
VISIT DATE: 01/15/2025
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Food Service: Facility has sufficient non-perishable and perishable food supply for residents in care. Sharps, pesticides and other cleaning solutions were kept locked and stored away from food areas.

Record Review: LPA requested staff files and Irene stated no staff files were available for review during the inspection. Irene stated that the files were at another facility to be copied and would be delivered to Canyon View Country Home during todays. Irene was informed that staff and residents files are required to remain at the facility at all times with all required information/training certificates.

A Technical Advisory has been issued due to the unavailability of a complete set of staff files when LPA requested them. Irene had the files delivered to the facility about 30 minutes into the inspection process. The administrator has committed to maintaining comprehensive files for both staff and residents at all times. Irene Creighton was provided with the LIC9242 checklist during the inspection to ensure all required documents are properly filed

Medical Related Services: The facility has a complete first aid kit. Resident's medication are centrally stored and kept in a locked cabinet and (2) two residents MARS/files was audited and it appears that their medications are being dispensed as prescribed by their physician.

An exit interview was conducted where this report was discussed and provided to Irene Creighton- Administrator at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
LIC809 (FAS) - (06/04)
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