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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209068
Report Date: 09/23/2020
Date Signed: 09/30/2020 03:00:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:HIGH DESERT HAVENFACILITY NUMBER:
157209068
ADMINISTRATOR:MATHEW, ABRAHAMFACILITY TYPE:
740
ADDRESS:1240 COLLEGE HEIGHTS BLVDTELEPHONE:
(760) 371-1989
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY:82CENSUS: 80DATE:
09/23/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Abraham Mathews, AdministratorTIME COMPLETED:
02:49 PM
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On this date, Licensing Program Analyst (LPA) L. Salazar contacted the facility to conduct a Pre-Licensing inspection via virtual conference due to COVID-19 and precautionary measures. LPA identified herself and discussed the purpose of the inspection with facility Administrator Abraham Mathews. Facility fire clearance for 82 non-ambulatory residents and delayed egress. Administrator certificate is current.

LPA conducted an annual inspection January 2020 and toured the facility inside and out. There have been no changes since inspection to the indoor or outdoor spaces. Passageways and exits were clear and free from obstruction. Smoke and carbon monoxide detectors were observed in required rooms and were functioning. Resident bedrooms and facility common areas were adequately furnished and lit. Hot water temperature was within required range. LPA reviewed facility the Emergency Disaster Plan LIC 610ES, current facility roster and completed Component III with Administrator.

Pre-Licensing is complete and this facility. No deficiencies observed. Exit interview conducted with Abraham Mathews and a copy of this report was provided via email. A read receipt confirms the licensees receive these documents.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2020
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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