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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800063
Report Date: 05/09/2024
Date Signed: 05/09/2024 08:58:20 AM


Document Has Been Signed on 05/09/2024 08:58 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:GARDENS OF RIVERSIDE, THEFACILITY NUMBER:
331800063
ADMINISTRATOR:GRISELDA T. GARCIAFACILITY TYPE:
740
ADDRESS:10849 ARLINGTON AVETELEPHONE:
(951) 637-8844
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:98CENSUS: 86DATE:
05/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Office Manager Joanna HandyTIME COMPLETED:
09:00 AM
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On 05/09/2024 at 08:30 AM, Licensing Program Analysts (LPAs) Melody Brown and Sarina Ramirez made an unannounced case management visit to amend the reports issued on 05/08/2024 for complaint # 56-AS-20230913100959 and 56-AS-20231204083515 . LPAs met with Business Office Manager Joanna Handy, introduced self and stated the purpose of the visit.

An exit interview was conducted where this report, LIC809 was discussed, reviewed and then provided to Business Office Manager Joanna Handy .
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2024
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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