<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604170
Report Date: 08/16/2022
Date Signed: 08/16/2022 03:39:07 PM

Document Has Been Signed on 08/16/2022 03:39 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:NOR LIVING LLCFACILITY NUMBER:
374604170
ADMINISTRATOR:RZOK, NAJAH JFACILITY TYPE:
735
ADDRESS:9027 AKARD STREETTELEPHONE:
(619) 335-0566
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 6CENSUS: 6DATE:
08/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Martha CollinsTIME COMPLETED:
02:35 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst Renita Hall (LPA) and Licensing Program Manager Denise Powell (LPM) conducted an unannounced Required 1 -Year Visit. The facility file was reviewed prior to the visit. LPA was greeted by Martha Collins, and identified herself to both LPA and LPM, and explained the purpose of the visit to the House Manager Martha Collins. All staff present have a current criminal record clearance.

LPA and LPM conducted a brief tour of the facility and observed the clients in care. In accordance with the Department Infection Control, LPM provided technical assistance, observed, and evaluated the facility's implementation of their Infection Control Plan, to include disinfection, testing surveillance, screening protocols, and the use of personal protective equipment. No deficiencies were cited or observed on this date.

An exit interview was conducted with House Manager Martha Collins. A copy of this report and the licensee appeal rights (LIC9058 01/16) were provided to the facility representative.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1