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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201285
Report Date: 12/08/2023
Date Signed: 12/08/2023 02:56:31 PM

Document Has Been Signed on 12/08/2023 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:NURTURE AT DEERSPRINGFACILITY NUMBER:
079201285
ADMINISTRATOR:TORRES, ADRIAN HAROLDFACILITY TYPE:
735
ADDRESS:5009 DEERSPRING COURTTELEPHONE:
(424) 362-6566
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 6CENSUS: 5DATE:
12/08/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Adrian Torres, Administrator and Flordeliza Cimarra, AdministratorTIME COMPLETED:
02:35 PM
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On 12/8/2023 at 01:05pm, Licensing Program Analyst (LPA) L. Hall conducted an announced pre-licensing inspection (facility is in operation and changing ownership). LPA met with Adrian Torres, Administrator and Flordeliza Cimarra, Administrator. The facility has an approved fire safety clearance for six (6) ambulatory clients. During inspection LPA observed three (4) clients and three (3) staff. The other client arrived from the day program.

LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, back yard. The facility has a total of five (5) bedrooms and two (2) bathrooms. Two (2) bedrooms are occupied by staff. No bodies of water observed. There is sufficient lighting around the facility. Clients rooms are equipped with the proper furniture, bedding, and lighting. Bathrooms showers/tubs were equipped with non skid mats. Passageways and hallways are free of obstruction. Locked cabinets available to store medications, toxins and sharps. Hot water temperature is measured at 122.1 degrees Fahrenheit. Fire extinguisher was last serviced on 6/13/2023. There is a minimum of 7-day non-perishables and 2-day perishables foods. First Aid kit was complete. Carbon monoxide and smoke detectors present.

No issues were noted during inspection. LPAs observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted with Administrator and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2023
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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