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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880753
Report Date: 10/28/2022
Date Signed: 10/28/2022 12:00:00 PM


Document Has Been Signed on 10/28/2022 12:00 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:JHEHAN FAITH LLCFACILITY NUMBER:
331880753
ADMINISTRATOR:TAGUBA, JENNIFER BFACILITY TYPE:
740
ADDRESS:5256 SIERRA VISTA AVENUETELEPHONE:
(717) 330-9409
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:6CENSUS: 4DATE:
10/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Heldo Taguba- Licensee TIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to the facility to conduct a required annual inspection, with an emphasis on infection control, due to the COVID-19 pandemic. LPA Bernadette Allen identified herself to Heldo Taguba- Licensee who was informed of the purpose of the visit.

LPA, Allen observed appropriate postings in the facility, including personal rights and visitation policies, which were in accordance with the Department's guidelines. LPA, Allen observed that the facility was also equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a supply of Personal Protective Equipment (PPE). LPA, Allen observed that the facility staff were wearing face coverings.

The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases and that staff are trained in the facility's infection control measures. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolation, and properly caring for clients with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the resident presents any COVID-19 symptoms.

LPA, Allen observed that the facility appeared to be meeting operational requirements. LPA, Allen observed that all utilities and appliances were functioning properly, and all passageways were clear of obstruction, including emergency exits. The facility was equipped with sufficient food supply including a 7-day of non-perishables and 2-day of perishables and emergency supplies. The facility has charged fire extinguishers, operating smoke alarms, and carbon monoxide detectors.

All inspected areas of the facility appeared clean and in good repair. LPA Allen observed no apparent health and safety risks at the time of visit.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:
DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: JHEHAN FAITH LLC
FACILITY NUMBER: 331880753
VISIT DATE: 10/28/2022
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Based on interviews and observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted where this report was discussed, and a copy was provided to Heldo Taguba- Licensee at the conclusion of the inspection.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC809 (FAS) - (06/04)
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