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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201285
Report Date: 12/04/2024
Date Signed: 12/04/2024 01:56:15 PM

Document Has Been Signed on 12/04/2024 01:56 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/
DIRECTOR:		TORRES, ADRIAN HAROLDFACILITY TYPE:
735
ADDRESS:5009 DEERSPRING COURTTELEPHONE:
(424) 362-6566
CITY:ANTIOCHSTATE: CAZIP CODE:
94531
CAPACITY: 6CENSUS: 6DATE:
12/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:41 PM
MET WITH:Adrian Torres, Administrator
Glady Ann Aquino, DSP (S1)		TIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 12/04/2024 at 12:30pm, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced annual required inspection. LPA met with staff (S1) and explained the purpose of the visit. Administrator holds a certificate 7006632735 that expires on 05/02/2026. The facility’s fire clearance was approved for six (6) ambulatory clients.

At 12:40pm, LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. The facility consists of five (5) bedrooms and two (2) full bathrooms. All indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for in facility is maintained at 75 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 110.8 degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. The supply of extra hygiene was available for clients.

Smoke detectors/carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 06/03/2024. First aid kit was observed to be complete.

Continued on next page, LIC 809-C
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: NURTURE AT DEERSPRING
FACILITY NUMBER: 079201285
VISIT DATE: 12/04/2024
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Continued from LIC809.

LPA reviewed five (5) staff and five (5) client files. All were current and complete.

Updated documents were obtained from administrator during visit:
  • Personnel Record (LIC 500)
  • Client Roster (LIC 9020)
  • LIC610D Emergency disaster plan including infection control
  • LIC308 (Designation of facility Responsibility)
  • Evidence of Surety Bond


No deficiencies cited during visit.

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Daisy Panlilio
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024
LIC809 (FAS) - (06/04)
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