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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370808527
Report Date: 10/01/2021
Date Signed: 10/03/2021 09:27:10 AM

Document Has Been Signed on 10/03/2021 09:27 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:NOAH HOMES, INC.FACILITY NUMBER:
370808527
ADMINISTRATOR:MOLLY NOCONFACILITY TYPE:
735
ADDRESS:12526 CAMPO ROADTELEPHONE:
(619) 660-6200
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91978
CAPACITY: 78CENSUS: 77DATE:
10/01/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
03:40 PM
MET WITH:Programs Assistant Valerie DavisTIME COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit to provide technical support regarding COVID-19. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Program Assistant Valerie Davis.

LPA evaluated the facility's COVID-19 screening, testing, and disinfection processes and staff use of personal protective equipment (PPE). LPA also briefly toured the facility, interviewed Davis, interacted with staff, and observed clients in care. The Department also provided additional relief PPE supplies. No deficiencies were cited on this date.

An exit interview was conducted with Davis, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2021
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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