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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530221
Report Date: 11/15/2024
Date Signed: 11/15/2024 12:03:05 PM

Document Has Been Signed on 11/15/2024 12:03 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:LOMA LINDA ASSISTED LIVINGFACILITY NUMBER:
365530221
ADMINISTRATOR/
DIRECTOR:
SANCHEZ, ELLEENFACILITY TYPE:
740
ADDRESS:25393 COLE STTELEPHONE:
(909) 799-3117
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY: 64CENSUS: 55DATE:
11/15/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:35 AM
MET WITH:Administrator Eileen SanchezTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Sarina Ramirez conducted an announced visit to the facility for the purpose of a Change of Ownership evaluation. LPA met with Administrator Eileen Sanchez. An initial application for change of ownership to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Centralized Applications Bureau (CAB) on 02/09/2024 for a total capacity of sixty-four (64) residents. Fire clearance was granted on 04/04/2024. LPA observed the following:

Eight (8) bedrooms and seven (7) bathrooms were inspected. There are no bodies of water. The physical plant, in general, was in good repair. Buildings and grounds are free from hazards. Indoor and outdoor passageways were free of obstruction. There is a charged fire extinguisher, operating smoke alarms, and carbon monoxide detectors. There is a locked area for medications, cleaning supplies, and sharps. LPA observed a working telephone and basic laundry equipment. Resident bedrooms had the required bedding and furniture. Bedrooms had sufficient lighting. LPA measured the hot water temperature in the resident bathrooms, and it ranged from 105 to 111 degrees F. The facility had a sufficient amount of linen and hygiene items for the residents. The facility had a sufficient amount of nonperishable and perishable food items. The food was kept in a safe and healthful manner. The facility menu was available for review. Dishes, glasses, and utensils were in good condition. The facility had a designated area for staff and resident records. Emergency disaster plan, emergency telephone numbers, personal rights, monthly activities, and complaint posters were posted in a common area. The facility was equipped with a complete first aid kit. There is adequate seating in the common areas. Facility had a supply of activities for the residents. Night lights were maintained in the hallways.

Pre-licensing inspection is complete, and no corrections are needed to be made. Facility appears to be ready for licensure. An exit interview was conducted where this report was discussed and provided to the Applicant Eileen Sanchez.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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