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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800108
Report Date: 01/12/2021
Date Signed: 01/12/2021 04:26:56 PM

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
RIVERSIDE, CA 92507
FACILITY NAME:A B CARING SENIOR LIVING 2FACILITY NUMBER:
331800108
ADMINISTRATOR:CARRASCO, REBECCAFACILITY TYPE:
740
ADDRESS:470 MEADOWLARK LANETELEPHONE:
(951) 435-7592
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY:6CENSUS: 5DATE:
01/12/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Licensee/Administrator Rebecca Carrasco TIME COMPLETED:
04:15 PM
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On 1/12/2021 Licensing Program Analyst (LPA) Javina George and Licensing Program Manager (LPM) Joel Esquivel conducted an announced informal meeting with Licensee/Administrator Rebecca Carrasco via Zoom due to COVID-19.

The informal meeting consisted of discussion regarding an open complaint and current staffing circumstances. LPA George will follow up with the Licensee/Administrator Rebecca Carrasco as needed.

An exit interview was conducted and a copy of this report was provided to Licensee/Administrator Rebecca Carrasco.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 01/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2021
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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