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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604264
Report Date: 11/07/2024
Date Signed: 11/07/2024 04:38:52 PM

Document Has Been Signed on 11/07/2024 04:38 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:NIR COMMUNITY IIIFACILITY NUMBER:
374604264
ADMINISTRATOR/
DIRECTOR:
HUQ, RANAFACILITY TYPE:
740
ADDRESS:10975 JANICE CTTELEPHONE:
(858) 414-5095
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY: 6CENSUS: 6DATE:
11/07/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Staff, Mila GalvanTIME VISIT/
INSPECTION COMPLETED:
12:05 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 (LPA), Natasha Persaud conducted a Case Management - Other visit. LPA was greeted and allowed entry into the facility by Staff, Mila Galvan. Licensee, Faria Huq and Administrator, Rana Huq arrived during the visit.

A visit was conducted to investigate an incident involving a resident. During staff interviews, it was discovered the resident does not reside at this facility. The incident will be addressed at the correct facility.

No deficiencies were observed today. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Staff, Mila Galvan whose signature below confirms receipt of these rights.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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