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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881193
Report Date: 09/01/2021
Date Signed: 09/01/2021 11:37:40 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:CANYON VIEW CARE HOMESFACILITY NUMBER:
361881193
ADMINISTRATOR:VERMANI, NITINFACILITY TYPE:
740
ADDRESS:6369 VINEYARD AVETELEPHONE:
(909) 548-1769
CITY:ALTA LOMASTATE: CAZIP CODE:
91701
CAPACITY:6CENSUS: 0DATE:
09/01/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Nitin VermaniTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Jennifer Semin conducted a pre-licensing inspection. LPA met with Licensee/Administrator, Nitin Vermani. The application is for a Residential Care Facility for the Elderly for two (2) ambulatory, three (3) non-ambulatory residents, one (1) bedridden resident and a hospice waiver for six (6).
A tour of the pending facility was conducted inside and out. Overall, the pending facility is clean and good condition. There are no pools, bodies of water, firearms or ammunition. LPA observed the bedrooms to be appropriately furnished with adequate lighting. Bathroom toilets, showers and tubs have grab bars and non-skid mats. The hot water temperature was measured in the resident’s bathroom at 105 degrees Fahrenheit. LPA observed food storage and preparation areas are clean and sanitary. Refrigerator and freezer temperatures are maintained at appropriate temperatures. All appliances are clean and operating properly. There is a sufficient supply of linens, towels and personal hygiene items. The first aid kit was reviewed; all items are present including a First Aid Manuel. LPA observed a minimal supply of recreation and leisure items and activities but licensee states he plans to add a variety of recreation and leisure items based on their resident’s preferences, once admitted. Outdoor space is suitable for resident use that includes a covered patio with a table and chairs. The fire extinguishers have been recently serviced and completely charged. Smoke alarms and carbon monoxide detectors are present and functional. Medications will be centrally stored and secured in a locked cabinet. All hazardous materials such as, cleaning and disinfecting supplies, knives and other sharps are locked and inaccessible to residents. All required forms are posted in a common area.
Pre-Licensing is complete, and this facility has no deficiencies.
Mr. Vermani was reminded of the statute that requires the licensee to contact LPA at CCLD 951-473-7024 within 5 business days of admitting their first resident. This notification may be done by phone, mail or fax.
An exit interview was conducted where this report was discussed and provided to Mr. Vermani
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Jennifer SeminTELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
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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