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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334808610
Report Date: 11/01/2019
Date Signed: 11/01/2019 09:18:11 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:RENU HOPE FOUNDATIONFACILITY NUMBER:
334808610
ADMINISTRATOR:SULTANA AHMADFACILITY TYPE:
850
ADDRESS:1675 N. PERRIS BLVD., #HTELEPHONE:
(951) 657-1395
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:95CENSUS: 49DATE:
11/01/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Elizabeth Gonzalez, Site SupervisorTIME COMPLETED:
09:25 AM
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On the date and time listed above, a case management visit was conducted by Licensing Program Analyst (LPA) Giselle Carbullido to deliver an amended report. During today’s visit, LPA toured the facility and census was taken, with 49 children present. LPA met with Elizabeth Gonzalez, Site Supervisor to deliver amended report.

An exit interview was conducted and a copy of this report and notice of site visit was provided to the Licensee. A copy of this report must be made available to the public for 3 years.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2019
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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