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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603801
Report Date: 03/13/2025
Date Signed: 03/13/2025 11:59:33 AM

Document Has Been Signed on 03/13/2025 11:59 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:CLAREMONT HACIENDA, THEFACILITY NUMBER:
198603801
ADMINISTRATOR/
DIRECTOR:		PEREZ,RICARDO LARAFACILITY TYPE:
740
ADDRESS:501 SOUTH COLLEGE AVENUETELEPHONE:
(956) 452-1554
CITY:CLAREMONTSTATE: CAZIP CODE:
91711
CAPACITY: 68CENSUS: 30DATE:
03/13/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:52 AM
MET WITH:Administartor Ricardo Lara-PerezTIME VISIT/
INSPECTION COMPLETED:
10:25 AM
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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Case Management visit on 03/13/2025, due to the facility closing on 05/21/2025. LPA Ramirez was greeted by Administrator Ricard Lara Perez and explained the purpose of the visit.

LPA Ramirez toured facility with Administrator Lara Perez. During tour, LPA Ramirez observed the facility activities room and Wing C was closed and inaccessible to residents due to renovations. Per Administrator Lara Perez, activities are now being conducted in the facility family room. LPA Ramirez observed several residents watching T.V. and socializing in family room. LPA Ramirez observed several staff providing care and supervision to residents in care. LPA Ramirez toured kitchen and observed sufficient food supply. Administrator Lara Perez agreed to send LPA Ramirez updates of resident relocations at least once a week.

No violations were cited during this visit. Exit interview was conducted. A copy of this report was provided via email.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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