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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370808527
Report Date: 04/17/2024
Date Signed: 04/17/2024 03:34:15 PM

Document Has Been Signed on 04/17/2024 03:34 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 DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:NOAH HOMES, INC.FACILITY NUMBER:
370808527
ADMINISTRATOR/
DIRECTOR:		SANDRA ROCCO-MELVILLEFACILITY TYPE:
735
ADDRESS:12526 CAMPO ROADTELEPHONE:
(619) 660-6200
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91978
CAPACITY: 78CENSUS: 77DATE:
04/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Kim Keane Director of Program DevelopmentTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Adrian Mangina conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility by Kim Keane Director of Program Development with whom LPA discussed the purpose of the visit.

According to the facility’s license, the facility has a maximum capacity of seventy-eight (78) clients. During today’s inspection, there were a total of seventy-seven (77) clients in care. Facility is licensed for 20 bedridden and 20 non-ambulatory residents. There are eight (8) separate homes. This facility does not feature a secured perimeter or delayed egress doors in the main campus. Memory Care houses has delayed egress available but it is not utilized for residents at this time.

LPA, accompanied by Kim Keane, toured the interior and exterior of the facility, and inspected the homes. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. LPA inspected a sampling of bedrooms, and all contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. Common spaces were toured. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperatures were compliant ranging from 68.4 to 72.5. Hot water temperature at taps accessible to clients were all compliant: ranging from 108.7F to 109.5F. Kitchen sinks were complaint, with temperatures averaging 115.4F.

The average Refrigerator temperatures were 40F and freezer temperatures were 0F. There were at least 2 days of perishable food, and at least 7 days non-perishable food present in all the facilities and all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic

continued on LIC809 page 2
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2024
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 DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: NOAH HOMES, INC.
FACILITY NUMBER: 370808527
VISIT DATE: 04/17/2024
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LIC809 page 2

chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas.

No pools or bodies of water on the premises. Per Licensee, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers (one at every house) were serviced within the last 12 months. First aid kits in med closets in every house was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed multiple staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance and surety bond. Administrator’s Certification expires 9/5/2024.

No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with Director of Program Development Kimberly Keane, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Adrian L Mangina
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2024
LIC809 (FAS) - (06/04)
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