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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881371
Report Date: 12/31/2024
Date Signed: 12/31/2024 02:51:46 PM

Document Has Been Signed on 12/31/2024 02:51 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:PROVIDENCE BASE CENTER INC.FACILITY NUMBER:
331881371
ADMINISTRATOR/
DIRECTOR:
ALOFE, OLUWAKEMI TFACILITY TYPE:
735
ADDRESS:27962 CALLE TALAVERATELEPHONE:
(951) 679-3499
CITY:MENIFEESTATE: CAZIP CODE:
92585
CAPACITY: 4CENSUS: 0DATE:
12/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:33 PM
MET WITH:Oluwakemi Alofe-AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Debbie Palacios made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Oluwakemi Alofe the Administrator who was informed of the purpose of the visit. The facility has a fire clearance for four (4) ambulatory and serves ages 18 through 59. LPA was notified by the Administrator that the facility did not have any clients or staff.

LPA toured the facility and reviewed Administrator's records. During the tour, LPA observed the facility is made up of a one-story home with four (4) client bedrooms and one(1) bedroom office with 2 bathrooms, a living room, dining room, kitchen, and attached garage. All client bedrooms had the required furniture, lighting, and closet storage. LPA toured the facility's exterior and observed outdoor pathways were free of obstructions. LPA tour the kitchen and Knives and sharp instruments were secured in a locked kitchen cabinet underneath the sink. LPA toured the garage and there is a locked cabinet with cleaning supplies and disinfected liquids. LPA observed a locked cabinet located in the living room area where the medications and logs will be stored. Administrator file reviewed had the Department's required training records and valid first aid/CPR certification and a current Administrator Certificate that will expire 02/04/2025. Administrator tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed one (1) charged fire extinguishers mounted in the kitchen, last serviced on 09/25/2024. Exit signs, emergency contact information, client's personal rights, and complaint information are visibly posted near the front entrance.

During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE: DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/31/2024
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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