374600284-10-10-2024-18-AS-JGEE-D9WPKY-20241010112354

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374600284
Report Date: 10/10/2024
Date Signed: 10/10/2024 11:23:59 AM

Document Has Been Signed on 10/10/2024 11:23 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	CEDAR A. R. F. II		FACILITY NUMBER:	374600284
ADMINISTRATOR/ DIRECTOR:	BALBINDER JAMMU		FACILITY TYPE:	735
ADDRESS:	29311 FOX RUN LANE		TELEPHONE:	(760) 751-8974
CITY:	VALLEY CENTER	STATE: CA	ZIP CODE:	92082
CAPACITY: 6		CENSUS: 6	DATE:	10/10/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:01 AM
MET WITH:	Balbinder Jammu, Licensee/Administrator		TIME VISIT/ INSPECTION COMPLETED:	11:30 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	On 10/10/24 Licensing Program Analyst LPA Javina George made an unannounced visit to the facility to conduct a 1 year required visit. LPA was greeted and granted entry by Licensee/Administrator Balbinder Jammu where LPA explained the purpose of the visit. At the time of the visit there was (1) staff and (0) clients present as they clients were at the day program. Below is a summary of observations made during today's inspection: A tour was conducted of the interior and exterior areas of the facility. The facility is a single story structure consisting of 5 bedrooms (2) of which are for the live in caregiver's and 2 bathrooms. The facility was observed to have an ample amount of Personal Protective equipment (PPE) supplies, emergency food and water. The emergency disaster drills are being conducted on a monthly basis, and the last drill was conducted on 09/10/24. The hot water was tested and measured at 105.8 degrees Fahrenheit, which is in regulatory limits of (105-120). The smoke and carbon monoxide detectors were tested and found to be operable . The facility was observed to have a fully charged fire extinguisher. There are no known guns or ammunition on the premises. The facility is in a high fire danger area, and the exterior was observed to be well manicured, no clutter or debris and the trees and shrubbery were observed to be cut. There is a covered patio that provides shade, and seating. The facility was observed to have ample activities for the clients to enjoy and encourage socialization. A records review was conducted and the staff files were observed to have obtained criminal record clearance and to be associated to the facility. Staff were observed to have the required training and valid CPR certification. In addition the facility administrator Balbinder Jammu was observed to possess a valid administrator with the certificate, that expires on 3/26/25. The client files were observed to have the

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CEDAR A. R. F. II	FACILITY NUMBER: 374600284
	VISIT DATE: 10/10/2024

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

admissions agreement, IPP, and medical assessment. The Personal and Incidental funds were verified and matched the amount indicated on the P&I form. The facility food supply observed to be sufficient, as there was a 2 day supply of perishables and a 7 day supply of non perishable food items.

The medications were observed to be given according to the Physician's instructions as evidenced by the Medication Authorization Record (MAR), all medications were present and are being stored in a locked medication cart. The sharps and chemicals and hygiene supplies were observed to be locked and inaccessible to clients in care.

Based on today's inspection no deficiencies were cited and the facility is in compliance with the California Code of Regulations (Title 22, Division 6, Chapter 6).

An exit interview was conducted and a copy of this report was reviewed and provided to Balbinder Jammu, Licensee/Administrator.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2