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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366413139
Report Date: 07/26/2024
Date Signed: 07/26/2024 03:08:49 PM

Document Has Been Signed on 07/26/2024 03:08 PM - It Cannot Be Edited

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
, CA 92507
FACILITY NAME:KALIA HOMEFACILITY NUMBER:
366413139
ADMINISTRATOR/
DIRECTOR:		PENDINGFACILITY TYPE:
735
ADDRESS:902 N. LINDEN AVETELEPHONE:
(909) 429-4418
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 4CENSUS: 3DATE:
07/26/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Administrator Fernando MelendezTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 07/26/2024 at 02:15 PM, Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to initiate a Case Management Health and Safety Check. LPA Brown was greeted and granted entrance to the facility by a staff and Administrator Fernando Melendez was contacted and met with LPA Brown. LPA Brown explained the purpose of today's visit.

During today's visit, LPA Brown toured the facility and conducted a health and safety check. Three (3) clients at the facility were present during the visit. No imminent health and/or safety concerns observed at the time of visit. LPA Brown observed no health and/or safety hazards inside the facility. LPA Brown inspected the outside perimeter of the facility and observed no health and/or safety hazards. LPA Brown observed sufficient staffs present at the facility to provide care and supervision. LPA Brown inspected facility food supplies and observed more than two (2) days’ supply of perishable food and more than seven (7) days’ supply of non-perishable food. The needs of the clients in care appear to be met during this inspection.

Moreover, on this visit, LPA Brown received copies of documentation pertinent to the incident reported.

An exit interview was conducted with Administrator Fernando Melendez, and a copy of this report (LIC809) was discussed and provided.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
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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