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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604874
Report Date: 02/13/2025
Date Signed: 02/13/2025 03:51:59 PM

Document Has Been Signed on 02/13/2025 03:51 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:VALLEY CARE HOME #1FACILITY NUMBER:
374604874
ADMINISTRATOR/
DIRECTOR:
CHARLTON, GARRICKFACILITY TYPE:
735
ADDRESS:2366 HIGHVIEW LNTELEPHONE:
(619) 931-9029
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 4CENSUS: 0DATE:
02/13/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Garrick Charlton, ApplicantTIME VISIT/
INSPECTION COMPLETED:
10:58 AM
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Licensing Program Analyst (LPA), Tiffany Holmes conducted an announced Pre-licensing inspection. An initial application to operate an Adult Residential Facility was received on 08/05/2024. The facility was approved to care for four (4) adult Residents; all ambulatory. LPA was greeted and allowed entry into the facility by and met with Applicant, Garrick Charlton.

Structure- The facility is a double story structure with 4 bedrooms and 3 bathrooms. There is an outdoor covered area for resident use. No bodies of water were observed.

Bedrooms Residents- Rooms #1, #2, #3, & #4, for ambulatory use only.


Bathrooms- All bathrooms have a working toilet, sink, tub/showers with non-skid mats.
Linens & Hygiene Supplies- Adequate supply.
Emergency Phone Numbers, Exit Plan and Required Postings- Posted.
Smoke Detectors and Carbon Monoxide Detectors- Interconnected and hardwired.
Appliances- Stove burners, oven, microwave, washer, and dryer working.
Toxins- Stored in a locked cabinet.
Water Temperature- Measured at 103.8, 107.6, and 108.1 degrees F.
Medications- Centrally stored and locked in a cabinet.
First-Aid Kit- Stored in a locked cabinet in the garage.
Resident & Staff Files- Located in cabinet in the garage.
Activities- Adequate supplies to include exercising, painting, and puzzles for resident's use.
Fire clearance- Approved on 10/17/24.

Component III- Conducted at the Pre-Licensing visit. Information provided about how to operate the facility within substantial compliance. All items reviewed during the visit are in compliance. Pre-licensing is complete and this facility has no deficiencies. Facility appears to be ready for licensure pending final review. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Applicant, Garrick Charlton and their signature below confirms receipt of these rights.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025
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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