<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530234
Report Date: 08/05/2024
Date Signed: 08/05/2024 10:04:21 AM

Document Has Been Signed on 08/05/2024 10:04 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: 0DATE:
08/05/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Victor ChiumiaTIME VISIT/
INSPECTION COMPLETED:
10:08 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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 was submitted to the Centralized Applications Bureau. LPA conducted an inspection of the facility, which included but not limited to the following:

Operation/Physical Plant: A fire clearance was granted by the San Bernardino Fire Department on 5/09/24 for a total capacity of five (5) clients, one of which was approved for non-ambulatory status. The facility has an infection control pland on file. Indoor and outdoor passageways were free of obstruction. The facility has no swimming pools or similar bodies of water. The facility window screens were observed to be in good repair. The facility has sufficient shaded outdoor space and sufficient indoor space for client activities. The facility is equipped with operating smoke/carbon monoxide alarms and laundry equipment. The facility has posted in a common area: emergency exiting plan and telephone numbers, Client personal rights, Community Care Licensing poster, activity calendar and facility visiting policy.

Bedrooms/Bathrooms: Client bedrooms are equipped with beds, bed linen, chairs, nightstands, storage space and sufficient lighting. Client bathroom equipment was in operating condition. The hot water temperature measured 118 degrees F. An operating night light was observed in the hallway area outside of client bathroom.

Food Service: The kitchen and dining areas are maintained clean. The facility has an adequate number of cups, dishes, and utensils for client use. The facility has a sufficient seven (7) day supply of non-perishable foods. The refrigerator and freezer have sufficient space for at least two (2) days of perishable foods. Sharps were kept in a locked drawer.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: 08/05/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
medications: The facility has a designated locked cabinet for client medications.

Supplies: The facility has sufficient supply of bed linen, towels, personal hygiene products, client activity items, emergency and first-aid products.

Records: The facility has a designated storage area for client and staff files.

The prelicensing inspection and the Comp III orientation is complete; no corrections are required.



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: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2