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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880584
Report Date: 09/26/2024
Date Signed: 09/26/2024 11:16:00 AM

Document Has Been Signed on 09/26/2024 11:16 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:NAVIN CAREFACILITY NUMBER:
361880584
ADMINISTRATOR/
DIRECTOR:		MARTIN, USHAFACILITY TYPE:
735
ADDRESS:12631 ALGONQUIN RDTELEPHONE:
(760) 240-5161
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 5CENSUS: 0DATE:
09/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Usha MartinTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced required 1-year visit to the facility. LPA met with Administrator, Usha Martin and discussed the purpose of the visit.

The facility is a two story, Adult Residential Facility (ARF) and a Inland Regional Center certified vendor. The facility has a license capacity of (5) and a current census of (0). The facility currently has no staff and no clients in care. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

LPA observed indoor and outdoor passageways are kept free of obstruction. The fenced backyard has sufficient shaded space for outdoor activities. No bodies of water were observed. The facility is maintained at a comfortable temperature. The facility is equipped with smoke/carbon monoxide alarms, fully charged fire extinguisher, laundry equipment and telephone service. The facility has sufficient supply of towels, linen, and personal hygiene products for clients. Posters such as client personal rights, emergency contacts, Community Care Licensing complaint poster were posted in a common area. The facility has a complete first aid kit with a first aid manual. The facility has a locked medication cabinet where medications will be stored. The facility has a designated cabinet to store client and staff files.

LPA inspected the kitchen. The facility has sufficient nonperishable and perishable storage space. Freezers and refrigerators are maintained in a safe and healthful manner. Facility has sufficient utensils, cups and plates. Sharps, disinfectants, cleaning supplies are kept in a locked cabinet.

LPA inspected client bedrooms and bathrooms. Bedrooms are equipped with beds, linen, nightstands, chairs, and lighting. Client bathroom equipment are operating in a safe and sanitary condition. The hot water temperatures tested at 108 degrees F. Nightlights were observed in hallways leading to client bathrooms.

Technical Advisories were issued and no deficiencies were cited during todays visit. An exit interview was conducted where this report was discussed, and a copy of this report was provided to the Administrator at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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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