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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601947
Report Date: 06/13/2023
Date Signed: 06/13/2023 01:19:56 PM

Document Has Been Signed on 06/13/2023 01:19 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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:NALAS ADULT RESIDENTIAL FACILITIES-CARLTONFACILITY NUMBER:
374601947
ADMINISTRATOR:LANGWORTHY, VERONICAFACILITY TYPE:
735
ADDRESS:2822 CARLTON WAYTELEPHONE:
(760) 451-9879
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 4CENSUS: 4DATE:
06/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:Chris Warner, AdministratorTIME COMPLETED:
01:15 PM
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On June 13, 2023, Licensing Program Analyst (LPA) Jacqueline Shaw Ross arrived unannounced at the above facility to conduct a required annual inspection. LPA Shaw Ross was greeted and granted entry by Lead Staff Steven Arias. LPA Shaw Ross introduced self, and stated the purpose of the visit. Administrator, Chris Warner joined shortly to conduct an overall tour of the facility inside and out.

The facility is a one-story, 3 bedroom, 2 bathroom home. At the time of the visit, 1 client and 3 staff were present. Administrator stated the other clients were at a day program. LPA observed 2 bedrooms that were shared with two clients per bedroom. The clients bedrooms were clean and appropriately furnished. The third bedroom is used for staff and office space. The facility appeared clean and free of odors throughout. All smoke and carbon monoxide detectors were tested and found operational. Food supplies are sufficient. Emergency food and water was stored in the garage. Hot water was measured in the clients bathroom and deemed safe at 123.6 degrees. LPA observed all toxic chemicals and other hazards secured and inaccessible to clients. Medications are centrally stored in a locked cabinet in the kitchen. Furniture in the home is in good repair. Outdoor space is free of hazards.

LPA inspected the staff and client records. Staff files had criminal record clearances and the required documentation including First Aid Certifications and training documents. Client records contained required documents and current information. P&I monies are kept in a locked safe in the hallway and are maintained separately from facility funds. LPA inspected medications and medications appear to be dispensed appropriately according to the physician's orders. The facility is completing emergency drills on a monthly basis. Staff interview was conducted and a client interview was attempted but client was unable to communicate effectively.

During the inspection, no deficiencies were observed.
An exit interview was conducted and a copy of the report and LIC 811 will be mailed to the Administrator.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2023
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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