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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530234
Report Date: 07/29/2024
Date Signed: 07/29/2024 11:43:02 AM

Document Has Been Signed on 07/29/2024 11:43 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:GARF LLCFACILITY NUMBER:
365530234
ADMINISTRATOR/
DIRECTOR:		CHIUMIA, VICTORFACILITY TYPE:
735
ADDRESS:16448 LIVE OAK STTELEPHONE:
(909) 647-6963
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 5CENSUS: DATE:
07/29/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Victor Chiumia-AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Magda Malcore conducted an announced pre-licensing visit to the facility. LPA met with Victor Chiumia, Administrator, and was granted entry into the facility. An initial application to operate an Adult Residential Facility (ARF) was submitted to the Central Applications Unit. A fire clearance was granted by the Fire Department - North Desert Office on 5/09/24 for a total capacity of five (5) clients, one of which is approved for non-ambulatory status. LPA observed the following:

Physical Plant (Indoor/Outdoor): Indoor and outdoor passageways were free of obstructions. No bodies of water were observed. The facility has sufficient lighting and is operating at a comfortable temperature. The facility has sufficient space for client activities. The facility has operating laundry equipment and carbon monoxide detectors. The facility's fireplace is screened. LPA observed the kitchen and food preparation areas are clean with an adequate number of cups, dishes, and utensils. Food storage cabinets are large enough for a seven (7) day supply of non-perishable foods. Refrigerators and freezers are maintained in operating in condition; there is enough storage for at least two (2) days of perishable foods. Sharps were kept in a locked in a drawer. The facility has a centralized locked cabinet which will be used for client records and medication. The facility has posted in a common area: client personal rights, emergency telephone numbers, and facility sketch.

The Administrator was informed that the facility is not ready for licensure as the following corrections are needed:


(1) Hot water temperature in the bathroom in clients bedroom measured 136 degrees F.
(2) Hot water temperature in the bathroom located in the hallway measured 143 degrees F.
(3) Night lights shall be maintained in hallways leading to client bathrooms.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2024
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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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: GARF LLC
FACILITY NUMBER: 365530234
VISIT DATE: 07/29/2024
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(4) Rugs shall be equipped with non-slip materials.
(5) facility shall have operating telephone service.
(6) All client bedrooms shall be equipped with chairs.
(7) All client bedrooms shall be equipped with bed springs/frames in good repair.
(8) The facility shall have sufficient activity supplies which include a variety of reading materials.

The Administrator shall provide documentation of corrections to the Licensing Agency. Comp III presentation was completed during today's visit. An exit interview was conducted were this report was discussed and a copy was provided to the Administrator at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024
LIC809 (FAS) - (06/04)
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