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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601947
Report Date: 06/28/2024
Date Signed: 06/28/2024 05:08:58 PM

Document Has Been Signed on 06/28/2024 05:08 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:NALAS ADULT RESIDENTIAL FACILITIES-CARLTONFACILITY NUMBER:
374601947
ADMINISTRATOR/
DIRECTOR:
LANGWORTHY, VERONICAFACILITY TYPE:
735
ADDRESS:2822 CARLTON WAYTELEPHONE:
(760) 451-9879
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 4CENSUS: 4DATE:
06/28/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:50 PM
MET WITH:Administrator Chris WarnerTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Administrator Chris Warner, who was informed of the purpose of the visit. At the time of the visit there was (5) staff and (4) clients present.

The facility is a one story home with (3) bedrooms and (2) bathrooms. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. The sharp and dangerous objects were observed to be locked and inaccessible to clients. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. Facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. The facility retains an emergency and disaster plan and emergency supplies. LPA reviewed documentation showing the facility's last fire drill 5/4/2024, which met the department requirements. LPA observed all facility exits were clear from obstructions.

LPA reviewed staff files and training. (4) client files were reviewed, and possessed all required paperwork. Client medications review and accounted for on MARS log. No deficiencies were cited at the time of the visit. An exit interview was conducted were this report was reviewed and provided.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2024
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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