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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609887
Report Date: 04/13/2021
Date Signed: 04/14/2021 02:49:10 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:FRANCES MANOR IIFACILITY NUMBER:
197609887
ADMINISTRATOR:PROVOST, EDNAFACILITY TYPE:
740
ADDRESS:25690 YUCCA VALLEY ROADTELEPHONE:
(323) 919-9331
CITY:VALENCIASTATE: CAZIP CODE:
91355
CAPACITY:6CENSUS: 6DATE:
04/13/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:57 PM
MET WITH:Paul Thompson - LicenseeTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) conducted an unannounced virtual visit to this facility to issue a citation regarding the recent cancellation of the corporation who owns this facility (MOTHER MARY'S BLESSED CARE FSH, LLC). Based on LPA's record review on the State Controller's office and the report of the licensee representative, the corporation was cancelled effective 10/07/2020.

The licensee representative reported on 04/06/2021 that the corporation was cancelled inadvertently and was not able to re activate per his conversation with the State Controller's office.

Inadvertent or not, this action, in effect, rendered the facility to operate without license. In this regard, Notice of Operation in Violation of Law is hereby issued. On 04/07/21 however, the licensee immediately send the new application packet to apply for a new license under MOTHER MARY'S BLESSED CARE LLC and was received by the Centralized Application Bureau (CAB) the next day. Therefore, no citation will be issued at this time.

LPA also conducted virtual physical plant tour and observed that the facility has a screening station with thermometer, log, hand sanitizer, pulse oximeter, disposable gloves and mask upon entrance, staff are wearing mask, have sufficient food both perishable and non-perishable, all clients seemed to be doing well and the facility is generally clean. There is a hot tub outside and appropriately fenced.

Exit interview conducted, copy of this report issued.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2021
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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