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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800158
Report Date: 10/24/2024
Date Signed: 10/25/2024 09:49:56 AM

Document Has Been Signed on 10/25/2024 09:49 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:IN-ROADS DAY PROGRAM 4FACILITY NUMBER:
331800158
ADMINISTRATOR/
DIRECTOR:		HILL, ANGELICAFACILITY TYPE:
775
ADDRESS:4120-4130-4140-4150 E. FLORIDATELEPHONE:
9098641551
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY: 60CENSUS: 16DATE:
10/24/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Administrator, Angelica HillTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Kathleen Banrasavong conducted an unannounced collateral visit to the facility in reference to Complaint Control Number: 18-AS-20241018143005. This collateral visit was conducted to conduct observations, client and staff interviews and records reviews. LPA met with Administrator, Angelica Hill- Garcia, who was informed of the purpose of the visit.

No health and safety issues were found during the time of the visit. An exit interview was conducted with Administrator, Angelica Hill-Garica, where this report was reviewed and provided to her.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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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