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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881158
Report Date: 07/31/2023
Date Signed: 07/31/2023 10:48:01 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 07/31/2023 10:48 AM - It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:OLIVER ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
331881158
ADMINISTRATOR:ADELEYE, JOHNPAULFACILITY TYPE:
735
ADDRESS:13675 OLIVER STREETTELEPHONE:
(951) 289-2731
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY: 6CENSUS: 0DATE:
07/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:House Manager Chibunna NwaobiaTIME COMPLETED:
11:00 AM
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On 7/31/2023, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to the facility to conduct an annual required visit. LPA contacted Corporate Board Member Ogonna Onyemata via telephone and informed them that LPA was at the facility for an annual inspection. Onyemata authorized Homeowner Chibunna Nwaobia to represent the facility during today's visit and informed LPA that there are currently no clients in care.

The facility is made up of a one-story home with six (6) bedrooms, four (4) bathrooms, family room, dining area, kitchen, and an attached garage. The facility is approved for four (4) ambulatory and two (2) non-ambulatory clients, and will serve adults ages 18-59.

LPA toured the facility and did not observe any clients in care. Per Homeowner Nwaobia, the facility is pending vendorization through Inland Regional Center (IRC) and the home has been vacant for two years.

During today's visit, LPA did not observe any issues or concerns. The facility will inform LPA when IRC vendorization is finalized and clients are scheduled to be placed at the home.

A copy of this report was reviewed and provided to Homeowner Nwaobia.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2023
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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