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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603484
Report Date: 08/20/2021
Date Signed: 08/20/2021 11:46:50 AM

Document Has Been Signed on 08/20/2021 11:46 AM - 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CANYON RIMFACILITY NUMBER:
198603484
ADMINISTRATOR:EVE, AUCIONE COELHOFACILITY TYPE:
735
ADDRESS:6512 BEQUETTE AVETELEPHONE:
(562) 395-8118
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY: 4CENSUS: 0DATE:
08/20/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Aucione EveTIME COMPLETED:
12:00 PM
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Licensing Program Analyst(LPA) Nicol Wesley conducted a follow up pre-licensing inspection and met with Applicant designee Aucione Eve and Leslie Eve. The facility will be licensed as an Adult Residential facility to serve 4 ambulatory consumers within the age of 18-59 years. There are currently no consumers in care. The facility phone number is 562 395 8118.

Today(08/20/21), the following items required prior to licensure were observed to be corrected/repaired/replaced:
  • Obtain screens/covering for the two open areas(crawl space/basement) on the outside that leads underneath the house. These were observed to be corrected during todays visit.

The following items are required prior to licensure:
  • CAB(Centralized Application Bureau) to finalize application.



If the applicant requires additional questions/concerns regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.

A hard copy of this report was given during the exit interview with Applicant designee Aucione.
SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Nicol Wesley
LICENSING EVALUATOR SIGNATURE: DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/20/2021
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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