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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426226
Report Date: 12/05/2024
Date Signed: 12/05/2024 03:44:05 PM

Document Has Been Signed on 12/05/2024 03:44 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:BAYCARE HOUSE LLCFACILITY NUMBER:
336426226
ADMINISTRATOR/
DIRECTOR:
NOAH WANGAIFACILITY TYPE:
735
ADDRESS:27309 BIG HORN AVENUETELEPHONE:
(951) 306-1323
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY: 4CENSUS: 0DATE:
12/05/2024
TYPE OF VISIT:Required - 1 YearANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:16 PM
MET WITH:Noah Wangai, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
NARRATIVE
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Licensing Program Analyst (LPA), Stephanie Martinez, made an announced visit to the facility for the purpose of conducting a required annual inspection. The LPA was greeted and allowed to enter the facility to conduct the inspection. On today’s visit the LPA met with Administrator, Noah Wangai; he was notified of the purpose for the visit. The LPA was informed there are currently no clients in care at this time.

PHYSICAL PLANT: Outdoor and indoor passageways were kept free of obstruction. No pool or body of water was observed on the property. According to the Administrator, there are no weapons kept in the home. A comfortable temperature was being maintained in the home. There was sufficient lighting in all rooms to ensure the comfort and safety of clients. Toilets, hand washing and bathing facilities were kept safe, sanitary, and in operating condition. Additional equipment for physically handicapped clients is available. The smoke and carbon monoxide alarms were tested and found to be operable. FOOD SERVICE: Sufficient supplies were observed to be available for client use, such as plates, cups, and silverware. RECORD REVIEW: The staff file was reviewed for Administrator Wangai. The required certification and training; including, but not limited to, Administrator's Certification and first aid training was observed on file. The Administrator, who was the only staff present at the time of the visit, had the required criminal record clearance on file. MEDICATION: A centrally stored location was observed to be available for the storage of client medications.

This report was reviewed with Administrator Wangai and a copy was provided. No deficiencies were cited at time of inspection. Administrator Wangai verbalized his understanding that the Department needed to be notified once a client is placed into the home to complete a reinspection.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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