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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881045
Report Date: 06/20/2023
Date Signed: 06/20/2023 11:33:35 AM

Document Has Been Signed on 06/20/2023 11:33 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:SAHARIA CARE HOMES INC.FACILITY NUMBER:
361881045
ADMINISTRATOR:MATHUR, BHARTIFACILITY TYPE:
735
ADDRESS:7531 STONEY CREEK DRIVETELEPHONE:
(909) 864-3184
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY: 4CENSUS: 4DATE:
06/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Sachin Mathur, AdministratorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct an annual inspection. LPA met with Sachin Mathur, Administrator and discussed the purpose of the visit.

The facility is an Adult Residential Facility (ARF) with a capacity of (4) and a census of (4). The facility is a 4 bedroom, 2 bathroom home with a kitchen/dining area, living room, family room and attached garage. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

LPA inspected the facility inside and out. Indoor and outdoor passageways were kept free of obstruction. The facility has no bodies of water and backyard is fenced with a self latching gate. Facility telephone service is working properly. The facility has sufficient furniture and lighting and is maintained at a comfortable temperature of 75 degrees F.

LPA inspected the kitchen. The hot water temperature tested within regulation at 105 degrees F. Facility has sufficient supply of nonperishable and perishable food. Facility has a variety of food available and a menu posted in the kitchen. Facility food is stored in a safe and healthful manner. Sharps are stored and kept locked in kitchen cabinet and inaccessible to clients in care.

LPA inspected client bedrooms. Bedrooms are equipped with mattresses, nightstands, chairs, storage space, linen and sufficient lighting. All bedroom furniture is in good repair.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SAHARIA CARE HOMES INC.
FACILITY NUMBER: 361881045
VISIT DATE: 06/20/2023
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LPA inspected the bathrooms. Bathrooms were operating in a safe and sanitary condition. The hot water temperature tested within regulation at 107 degrees F.

LPA observed the facility is equipped with operating carbon monoxide alarms and fully charged fire extinguishers which were serviced December 2022. Posters such as personal rights, emergency disaster plan, Licensing complaint contact, were posted in a common area. Cleaning supplies, toxins, items were kept locked and inaccessible to clients in care.

LPA reviewed (4) client medications. Medications were dispensed appropriately according to the physician's orders. LPA observed medications are kept in a safe and locked cabinet inaccessible to clients. Facility has complete first aid kits and emergency supplies.

LPA reviewed four (4) client files for admission agreements, physician reports, and Individual Program Plan (IPPs), all had the required documentation. LPA reviewed (2) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings, all had the required documentation.

Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care. No deficiencies were cited during today's visit.

An exit interview was conducted where this report was discussed and a copy was provided to Sachin Mathur at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC809 (FAS) - (06/04)
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