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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881065
Report Date: 02/10/2025
Date Signed: 02/10/2025 12:43:14 PM

Document Has Been Signed on 02/10/2025 12:43 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 BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:YORKSHIRE GARDEN CARE #1FACILITY NUMBER:
361881065
ADMINISTRATOR/
DIRECTOR:		LALA, ADETUTU E.FACILITY TYPE:
740
ADDRESS:12667 YORKSHIRE DRIVETELEPHONE:
(760) 605-4674
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY: 6CENSUS: 0DATE:
02/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Adetutu LalaTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Magda Malcore made a visit to the facility to conduct a required annual inspection. LPA met with Adetutu Lala, Administrator, and discussed the purpose of the visit.

The facility is a four (4) bedroom, two (2) bathroom Residential Care Facility for the Elderly (RCFE). The facility has a license capacity of (6) and a current census of (0) residents in care. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility has no swimming pools or similar bodies of water. Outdoor shaded area is sufficient for resident activities and is enclosed with a self-latching gate. Outdoor furniture was observed to be in good condition. The facility has sufficient lighting and indoor space for resident activities. Resident’s bathrooms are operating in a safe and sanitary condition. The hot water temperature in residents' bathrooms measured 118 degrees F. Resident’s bedrooms had beds, bed linen, dressers, and lighting. Facility is equipped with smoke/carbon monoxide alarms, laundry equipment, two (2) covered fireplaces, hallway night lights, fully charge fire extinguisher, first aid kit, and telephone service. The facility has posted in a common area, Community Care Licensing complaint poster, Ombudsman poster, personal rights, rights of resident council, facility license, menu, and emergency telephone numbers. Sharps, disinfectants, and cleaning solutions were kept locked in a locked cabinet. The facility has a locked area where resident and staff files will be stored. The facility has a locked cabinet where resident medications will be stored.

Food Service: Facility kitchen and two (2) dining areas are maintained clean. The facility has sufficient kitchenware, utensils, and food storage areas
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: YORKSHIRE GARDEN CARE #1
FACILITY NUMBER: 361881065
VISIT DATE: 02/10/2025
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Care & Supervision: The facility currently has no staff or residents in care.

Record Review: The facility's infection control plan, emergency and disaster plan, and insurance are current. The facility has no staff or residents in care to conduct a file review.

No deficiencies were cited during today’s visit. An exit interview was conducted where this report was discussed and a copy provided to the Administrator at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025
LIC809 (FAS) - (06/04)
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