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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601947
Report Date: 03/19/2025
Date Signed: 03/19/2025 11:42:14 AM

Document Has Been Signed on 03/19/2025 11:42 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 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:
03/19/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Acting Administrator, Marchelino RoosTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 3/19/2025, Licensing Program Analyst (LPA) Janette Romero arrived unannounced to the facility to conduct a case management visit to deliver an Immediate Exclusion order for Staff, Christian Umana. LPA was greeted and granted entry by Caregiver, Jacko Leon who was informed of the purpose of the visit. During the visit, Acting Administrator (AA) Marchelino Roos arrived to the facility to meet with LPA and was also informed of the purpose of the visit.

During today's visit, LPA toured the facility’s interior and exterior with Caregiver, Jesus "David" Salvador and did not observe Umana present in the facility. LPA phoned Director, Peyton Crow who reported Umana was last present in the facility on 3/11/2025. AA Roos also reported Umana's last day present in the facility was on 3/11/2025. LPA provided AA Roos the Immediate Exclusion order dated 3/18/2025 regarding Umana. No citations were issued during today’s visit. An exit interview was conducted and this report was reviewed over the phone with Director Crow and in person with AA Roos. A copy of this report was provided to AA Roos.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 03/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/19/2025
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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