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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602563
Report Date: 08/24/2023
Date Signed: 08/24/2023 01:57:58 PM

Document Has Been Signed on 08/24/2023 01:57 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:RAHMAAN HOMEFACILITY NUMBER:
198602563
ADMINISTRATOR:RAHMAAN, ALMAFACILITY TYPE:
735
ADDRESS:1345 ASHPORT STTELEPHONE:
(909) 622-0662
CITY:POMONASTATE: CAZIP CODE:
91768
CAPACITY: 4CENSUS: 3DATE:
08/24/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Jamila Rahmaan, StaffTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to continue the annual inspection. LPA arrived unannounced and met with Staff, Jamila Rahmaan. Administrator, Alma Rahmaan, arrived shortly thereafter to assist LPA. The initial inspection was held on 8/22/23.

During the visit today, LPA continued with the remainder of the CARE tool and observed the following.

LPA reviewed 3 Staff files and the required documents are placed in their files. They are receiving on-going annual training. Staff are all over the age of 18 and associated to the facility. The administrator's certificate expires on 12/2/24. The smoke detectors and carbon monoxide detector are operable. The hot water temperature was measured within the required range of 105 to 120 degrees F. The facility has the updated LIC610D - Emergency and Disaster Plan that includes relocation sites, utilities shut off valves, and procedures for evacuation.

LPA provided a technical assistance for the quarterly disaster drills. An exit interview was held and a copy of the report was provided to the administrator.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023
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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