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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366425834
Report Date: 05/31/2024
Date Signed: 05/31/2024 12:04:26 PM


Document Has Been Signed on 05/31/2024 12:04 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:FOREMOST SENIOR CAMPUSFACILITY NUMBER:
366425834
ADMINISTRATOR:NIRUPAMA VANGALAFACILITY TYPE:
740
ADDRESS:17581 SULTANA STREETTELEPHONE:
(760) 244-5579
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:96CENSUS: 77DATE:
05/31/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Danica Turner-AdministratorTIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPA) Paola Guerrero conducted an unannounced visit to the facility on 5/31/2024 at 09:09 AM for the purpose of a Health & Safety check. LPA Guerrero identified herself to Facility Administrator Danica Turner and discussed the purpose of the visit. Residents in care were present during visit. No imminent health and/or safety concerns observed at the time of visit. LPA Guerrero observed no health and/or safety hazards inside the facility. LPA Guerrero inspected the outside perimeter of the facility and observed no health and/or safety hazards. LPA Guerrero observed sufficient staff present at the facility to provide care. LPA Guerrero inspected facility food supplies and observed three (3) day supply of perishable and seven days (7) supply of non-perishable food. The needs of the residents in care appear to be met during this inspection.

An exit interview was conducted where this report (LIC809) was discussed and provided to Facility Administrator Danica Turner.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola GuerreroTELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2024
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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