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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800114
Report Date: 06/02/2020
Date Signed: 06/30/2020 10:45:04 AM

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:VINEYARD RANCH AT TEMECULAFACILITY NUMBER:
331800114
ADMINISTRATOR:AREVALO, DONNAFACILITY TYPE:
740
ADDRESS:27350 NICOLAS RDTELEPHONE:
(951) 308-1988
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY:125CENSUS: 83DATE:
06/02/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:32 AM
MET WITH:Gregory Case, Executive DirectorTIME COMPLETED:
09:33 AM
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Licensing Program Analyst, Deborah Mullen contacted Gregory Case, Executive Director, utilizing the Facetime application to initiate an investigation of complaint control # 18-AS-20200601103146. During the visit LPA Mullen conducted a Health and Safety Inspection of the facility. LPA did not observe any health and safety concerns during the inspection.

This report was reviewed with Mr. Case by phone and emailed for his review and signature.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2020
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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