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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600839
Report Date: 12/26/2025
Date Signed: 12/26/2025 11:53:44 AM

Document Has Been Signed on 12/26/2025 11:53 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:NALAS RESIDENTIAL FACILITY #2FACILITY NUMBER:
374600839
ADMINISTRATOR/
DIRECTOR:		HUBER BARQUEROFACILITY TYPE:
735
ADDRESS:945 BUENA SUERTETELEPHONE:
(760) 723-8706
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 6CENSUS: 6DATE:
12/26/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Administrative Assistant, Garrett CrowTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On 12/26/2025, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Caregivers, Marvin Munoz Fuentes and Yolanda Munoz Rodriguez who were informed of the purpose of the visit. LPA contacted Administrator Huber Barquero who was also informed of the purpose of the visit. Administrative Assistant, (AA) Garrett Crow arrived to the facility to meet with LPA. The facility has a fire clearance to serve six (6) ambulatory adults ages 18-59. During today's visit, LPA did not observe any clients present and LPA was informed the clients were out in the community attending day program.

LPA toured the facility with AA Crow and observed the facility is made up of a one-story home with three (3) client bedrooms, two (2) living rooms and dining areas, a kitchen, laundry room, and attached garage. Client bedrooms had the required bedding, furniture, and lighting. The bathroom had a grab bar and in the shower and near the toilet. LPA also observed toilet paper and soap readily available in the bathroom. No bodies of water were observed on the premises. Indoor and outdoor pathways were free of obstruction. The facility met Departmental requirements for a two-day supply of perishable foods and seven-day supply of non-perishable foods. Medications are secured in a locked kitchen cabinet. AA tested one (1) of the smoke alarms/carbon monoxide detectors and LPA heard it to be operational. LPA also observed a charged fire extinguisher mounted in the kitchen last serviced on 05/15/2025 and a fire alarm pull station in the hallway leading to the clients' bedrooms.

NAME OF LICENSING PROGRAM MANAGER: Carolyn Tuba
NAME OF LICENSING PROGRAM ANALYST: Janette Romero
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 12/26/2025 11:53 AM - It Cannot Be Edited


Created By: Janette Romero On 12/26/2025 at 09:41 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: NALAS RESIDENTIAL FACILITY #2
FACILITY NUMBER: 374600839

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/26/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80019(f)(1)
80019 Criminal Record Clearance
(f) A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another, or from TrustLine to a state licensed facility by providing the following documents to the Department:
(1) A signed Criminal Background Clearance Transfer Request, LIC 9182 (Rev. 4/02).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above by not submitting an LIC9182 to request the transfer of the criminal record clearance for Caregivers Marvin Munoz Fuentes and Yolanda Munoz Rodriguez, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 12/30/2025
Plan of Correction
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Administrator Barquero reported he will submit an LIC 9182 for Caregivers Marvin Munoz Fuentes and Yolanda Munoz Rodriguez along with all additional required documentation by close of business on 12/30/2025. Administrator Barquero added they will gain access to Guardian for all of licensee's facilities.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Carolyn Tuba
NAME OF LICENSING PROGRAM MANAGER:
Janette Romero
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/26/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/26/2025


LIC809 (FAS) - (06/04)
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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: NALAS RESIDENTIAL FACILITY #2
FACILITY NUMBER: 374600839
VISIT DATE: 12/26/2025
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LPA reviewed the Record of Client's/Resident's Safeguarded Cash Resources (LIC 405) for all clients while AA reviewed their physical monies and no discrepancies were discovered. LPA also reviewed the facility's Fire Evacuation Drill Log noting the facility's last fire drill was conducted on 12/09/2025. Clients' personal rights, complaint procedures, emergency disaster plan, and facility sketch are posted by the dining room closest to the main entrance. Caregivers present have a criminal record clearance and were associated to one of licencee's sister facilities under the jurisdiction of a different regional office. Yolanda and Marvin were interviewed and both reported working in this facility for the past three (3) years. However, they are not associated with this facility. Administrator Barquero and AA reported they did not have access to the Department's Guardian Background Check System to update the facility's staff roster during LPA's visit due to the facility's corporate office being closed today. Administrator Barquero reported he is aware the facility must submit a Criminal Background Clearance Transfer Request (LIC 9182) to request to associate an employee with the facility. Administrator Barquero reported he submitted an LIC 9182 to the Riverside Regional Office requesting the clearance transfer for both caregivers. However, he was unable to provide proof of submittal prior to them working in this facility. As a result, a deficiency and civil penalty will be issued. During today's visit, LPA did not observe any additional issues or concerns. An exit interview was conducted and a copy of this report, LIC 809-D, LIC421BG, and Appeal Rights were reviewed and provided to AA Crow.
NAME OF LICENSING PROGRAM MANAGER: Carolyn Tuba
NAME OF LICENSING PROGRAM ANALYST: Janette Romero
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2025
LIC809 (FAS) - (06/04)
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