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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600867
Report Date: 09/08/2022
Date Signed: 09/08/2022 03:11:42 PM

Document Has Been Signed on 09/08/2022 03:11 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:NOAH HOMES, INC.-CASA DE LAS PALMASFACILITY NUMBER:
374600867
ADMINISTRATOR:MOLLY NOCONFACILITY TYPE:
735
ADDRESS:12634 OLD CAMPO ROADTELEPHONE:
(619) 660-6200
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91978
CAPACITY: 6CENSUS: 0DATE:
09/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Hazel Tapit, Residential Support Manager and
Tina CruseQuinagon, Senior Residential Support Manager, 		TIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced required 1 -year visit. LPA was greeted and allowed entry to the facility by Hazel Tapit, Residential Support Manager, to whom LPA discussed the purpose of the visit. Also present was Tina CruseQuinagon, Senior Residential Support Manager.

LPA conducted a tour of the facility with Hazel Tapit, Residential Support Manager. In accordance with the Department’s Infection Control program, LPA provided technical assistance and observed and evaluated the facility's implementation of their COVID-19 Mitigation Plan (LIC 808).

LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff and visitors; A sign-in policy enacted for all visitors; Face coverings worn by staff; Hand sanitizer/hand washing stations readily available; A designated visitation area; Emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of PPE (Personal Protective Equipment). Based on observations, the facility is in compliance with and has implemented infection control practices as outlined in their LIC 808.

No deficiencies were observed during today's visit. An exit interview was conducted with Hazel Tapit, Residential Support Manager and Tina CruseQuinagon, Senior Residential Support Manager, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided to Hazel Tapit, Residential Support Manager
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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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