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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881371
Report Date: 12/10/2025
Date Signed: 12/10/2025 04:04:54 PM

Document Has Been Signed on 12/10/2025 04:04 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:
12/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:33 PM
MET WITH: Oluwakemi Alofe, Administrator TIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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On 12/10/25 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a 1 year required visit. LPA met with Oluwakemi Alofe the Administrator and informed of the purpose of the visit. The facility is licensed to serve four (4) ambulatory, ages 18 through 59. The facility is open but does not have any clients residing in the facility. Per the Alofe, the facility has completed the vendorization process but has not received any referrals for placement's.
The facility is equipped with solar panels and was observed to be clean and clutter free. The client bedrooms were observed to have the required furniture (bed, chest of drawers, night stand and chair). The sharps are stored in a locked cabinet underneath the sink. The emergency food and water are being stored inside the garage. The chemicals are stored inside a locked cabinet inside the garage. The extra linen was observed to be inside a closet inside the client bathroom. The required postings are posted as well as staff and client files will be stored in a closet inside the entryway. The medications will be stored inside a locked file cabinet inside the living room and dining area. The combined and intertwined smoke and carbon monoxide detectors were tested and found to be operable. There are no guns, ammunition or bodies of water on the premises. There is one (1) fully charged fire extinguisher mounted in the kitchen, that was last serviced on 09/08/25. The dishes, pots pans, and utensils were observed to be in good repair. The hot water temperature was checked and measured to be 110.4 degrees Fahrenheit. A file review was conducted and the governing body was observed to be in good standing in addition to the facility annual fees have been paid, and the facility contact information on file is accurate. A records review of Oluwakemi Alofe, Administrator file and was observed to have CPR certification that expired on 12/21/26, as well as a valid administrator certificate that expires on 02/04/27. Based on today's inspection no citations were issued in accordance with with the California Code of Regulations (Title 22, Division 6, Chapter 6). An exit interview was conducted where a copy of this report was reviewed and provided to Oluwakemi Alofe, Administrator.
NAME OF LICENSING PROGRAM MANAGER: Carolyn Tuba
NAME OF LICENSING PROGRAM ANALYST: Javina George
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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