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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530203
Report Date: 09/25/2024
Date Signed: 09/25/2024 02:03:11 PM

Document Has Been Signed on 09/25/2024 02:03 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:PLATINUM SKILL PROFESSIONALS, INC.FACILITY NUMBER:
365530203
ADMINISTRATOR/
DIRECTOR:		BARRETT, QUINNOLFACILITY TYPE:
740
ADDRESS:13625 SIERRA VISTA DR.TELEPHONE:
(888) 342-2732
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY: 6CENSUS: 0DATE:
09/25/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Quinnol Barrett, Administrator/LicenseeTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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On 9/25/2024 at 10:45 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required post licensing inspection. LPA Serrano met with Licensee/Administrator Quinnol Barrett and was granted entry to the facility. At the time of the visit there was no staff present, and no resident present.

The facility is a three (3) bedrooms, two (2) bathrooms home with a kitchen/dining area, living room/activity room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of six (6) ambulatory residents and the current census is zero (0) resident. LPA Serrano was accompanied by the Licensee/Administrator Barrett 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 Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 68 degrees Fahrenheit. LPA Serrano 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 Serrano observed sufficient furniture and lighting throughout the facility. LPA Serrano measured and observed the water temperatures in the bathroom to be at 117 degrees Fahrenheit. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Fire extinguishers were also observed at the facility. Posters such as personal rights, the CCLD complaint poster, labor laws, and the disaster plan were posted in a common area. LPA Serrano observed no resident right now.

***Continuation in LIC809C ***

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
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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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: PLATINUM SKILL PROFESSIONALS, INC.
FACILITY NUMBER: 365530203
VISIT DATE: 09/25/2024
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Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine cabinet for future resident’s medications locked. LPA Serrano observed complete first aid kit and first aid book at the facility.

Food Service: More than seven (7) days’ supply of Non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care.

Care & Supervision: The facility has an Administrator 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. Also, LPA Serrano observed that the facility does not have dementia resident.

Record Review: LPA Serrano reviewed zero (0) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPA Serrano reviewed one (1) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings.

Based on the observations made during today’s visit, no deficiency were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report LIC809, was discussed and provided to Licensee/Admiistrator Quinnol Barrett.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2024
LIC809 (FAS) - (06/04)
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