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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804249
Report Date: 09/26/2024
Date Signed: 09/26/2024 01:39:15 PM

Document Has Been Signed on 09/26/2024 01:39 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:RHOME CARES LLCFACILITY NUMBER:
486804249
ADMINISTRATOR/
DIRECTOR:		NARULA, BITTUMFACILITY TYPE:
735
ADDRESS:480 PHOENIX CIRCLETELEPHONE:
(510) 366-4131
CITY:VALLEJOSTATE: CAZIP CODE:
94589
CAPACITY: 4CENSUS: 0DATE:
09/26/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Bittum Narula (Applicant)TIME VISIT/
INSPECTION COMPLETED:
01:54 PM
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Licensing Program Analyst (LPA) Cuadra arrived announced to conduct a Pre-licensing Inspection and Component III. LPA met with applicant Bittum Narula to toured the inside of the facility and grounds.

LPA/Applicant toured the facility and observed the following. This is a one story residence with four bedrooms, two bathrooms, living room, dinning room, staff room, backyard area, staff office, kitchen and garage area. Cameras located outside are part of security system as well as auditory alarms. Fire clearance granted by City of Vallejo on 7/3/2024, granting capacity of 4 and all ambulatory. All rooms and common area had sufficient lighting, including hallways. The smoke alarms are hardwired and observed operational during inspection. Carbon Monoxide Detector observed and functioning. LPA observed fire extinguishers charged. Water temperature was measured at 109.2 degrees F, which is between 105 & 120 degrees F. There are two cabinets in the kitchen that will be used for medications and knives. Lockable file cabinet located in the garage will maintain binders for client and staff records. LPA/Applicant observed cleaning supplies and toxins are locked in a cabinet in garage area. The Applicant do not have a first aid kit with manual. Amble supply of linens, hygiene products, cooking utensils, pots/pans and dishes observed. All bathrooms have non-skid flooring in showers. All appliances in the kitchen were working properly. Clients bedrooms had the required furnishings, such as a dresser, night stand, lamp and bed linens, except for bedroom #4. Applicant informed LPA that they will be handling clients P&I money and they agreed to stored at the facility, ledgers will be current for CCL review. Bittum Narula Administrator Certificate 6068757735 expires 4/17/2026. Once approved from CCL, Applicant will start the process with Regional Center for vendorization.
Continues on LIC809C...
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: RHOME CARES LLC
FACILITY NUMBER: 486804249
VISIT DATE: 09/26/2024
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Applicant agrees to submit the following items for LPA review:
  • 1st aid kit with manual.
  • proof of lockable cabinet for knives and medications.
  • proof of required postings (CCL complaint poster and visitor policy)
  • Room # 4 needs to have bed and required furniture which was observed available in the garage, but needs to be placed in the bedroom.

LPA will conduct inspection after above items are submitted to confirm completion. After confirmed LPA will notify Application Unit pre-licensing inspection is complete and to proceed with licensure. Component III was completed with Applicant. Exit interview conducted with Applicant and a copy of this report was given.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC809 (FAS) - (06/04)
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