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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804286
Report Date: 01/16/2025
Date Signed: 01/16/2025 12:29:14 PM

Document Has Been Signed on 01/16/2025 12:29 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:NEEMA HOMES LLCFACILITY NUMBER:
486804286
ADMINISTRATOR/
DIRECTOR:		NGATA, STEPHENFACILITY TYPE:
735
ADDRESS:1001 YATELEY COURTTELEPHONE:
(562) 353-0990
CITY:VACAVILLESTATE: CAZIP CODE:
95687
CAPACITY: 4CENSUS: 0DATE:
01/16/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Stephen Ngata, Administrator and Agnes Mbithi, co-AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Jill Nakagawa arrived to conduct an announced pre-licensing inspection on 01/16/2025. LPA met with Licensee/Administrator Stephen Ngata and Co-Administrator Agnes Mbithi.

The facility has a fire clearance approval from the Vacaville Fire Department for a total capacity of 4 Clients: 2 ambulatory and 2 non-ambulatory. The 2 non-ambulatory clients are restricted to bedrooms 1 and 2. Facility will operate with 24/7 staffing and Licensee will ensure sufficient staffing at all times. The facility is a one-story home, with 4 bedrooms, 2 bathrooms, a kitchen, living room, dining room and a small office. There is also a gazebo in the back yard. Outdoor furniture to be delivered 01/18/2025. There are also raised flower beds for clients to use for gardening activities. Water temperature was within regulation, within 105-120 degrees F.

The facility has a fire sprinkler system, with smoke and carbon monoxide sensors installed throughout. There are 2 fire extinguishers; one mounted in the kitchen and one in the laundry room. Purchased on 10/17/2024; fully charged. The emergency disaster plan was posted, with two emergency disaster locations. Emergency supplies will be purchased and stored in the garage, including water, food and to-go bags.

First aid kit had all components required per regulation. Emergency lighting will available, including night lights and flashlights. Bedrooms were furnished as per regulation with chairs, dressers, beds, appropriate lighting and an appropriate supply of linens. Bathrooms had hand washing supplies and paper products. There was a sufficient amount of cleaning supplies and hygiene products available. Toxins will be secured in the garage, which is locked and alarmed. Medication will be locked in cabinets in hallway and above refrigerator, locked and inaccessible to clients in care.

Continued on 809-C
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2025
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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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: NEEMA HOMES LLC
FACILITY NUMBER: 486804286
VISIT DATE: 01/16/2025
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All required postings have been ordered and will be posted prior to 01/23/2025. Proof to be sent to LPA Nakagawa.

LPA conducted a COMP III with applicants. The following items were discussed: Reporting Requirements, Clients behaviors and Personal RIghts, Personal Accommodations, Criminal Background clearance, Acceptance and Retention, Guardian, Restricted and Prohibited Health Care Conditions.

LPA found no concerns.

This pre-licensing is complete. LPA will submit the pre-licensing reports to the Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicants of application status. A copy of the report was given to the Applicants.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Jill Nakagawa
LICENSING EVALUATOR SIGNATURE:

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC809 (FAS) - (06/04)
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