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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603300
Report Date: 08/07/2026
Date Signed: 08/07/2026 10:01:08 AM

Document Has Been Signed on 08/07/2026 10:01 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BANYAN ARFFACILITY NUMBER:
374603300
ADMINISTRATOR/
DIRECTOR:		DARA CROWFACILITY TYPE:
735
ADDRESS:1323 BANYAN DRIVETELEPHONE:
(760) 728-1618
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 4CENSUS: 4DATE:
08/07/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:08 AM
MET WITH:LEAD CAREGIVER, JUAN ARGUELLOTIME VISIT/
INSPECTION COMPLETED:
10:18 AM
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On August 07, 2026, Licensing Program Analyst (LPA), Venus Mixson made an unannounced visit to the facility to conduct the Required Annual visit and met with Juan Arguello. The facility is licensed to serve four Developmentally Disabled Adults, two of which may be non-ambulatory.
The home is a single story structure consisting of five bedrooms and two bathrooms, kitchen garage, backyard, dining area and family room. LPA observed that there are no pools or bodies of water on the premises at the time of this visit. The hot water temperature tested within regulations and was logged. LPA observe the facility was clean and free of clutter and debris. The facility was observed to have the required postings such as personal rights, complaint poster, and license. The food supply was adequate as the facility was observed to have a two day supply of perishable and a seven day supply of nonperishable food items. The medications and sharp objects were locked in a cabinet located inside the kitchen. The bedrooms were observed to have the required furniture, and linens. The facility has a fully charged fire extinguisher, and the smoke and carbon monoxide detectors were operable at the time of this visit.
The facility conducts emergency disaster drills on a monthly basis; the last drill was current at this visit. LPA conducted a review of the records. Each file reviewed were observed to have the required documents at the time of this visit. Staff records reviewed were observed to have current CPR certification, with staff having obtained proper fingerprint clearance and to be associated to the facility. The Administrator on record Dara Crow has a valid administrator certificate with an expiration date of 07/18/2027. Resident P&I personal and Incidental funds were reviewed and were accounted for and balanced.
The facility has an ample supply of personal protective equipment. LPA conducted a file review and found that the annual licensing fees are current. Based on today's inspection no deficiencies were observed. An exit interview was conducted, and a copy of this report was discussed and given to House Manager Juan Arguello.
Jazmond D Harris
Venus Mixson
DATE: 08/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2026
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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