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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880492
Report Date: 05/17/2023
Date Signed: 05/17/2023 09:45:54 AM

Document Has Been Signed on 05/17/2023 09:45 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
RIVERSIDE, CA 92507
FACILITY NAME:COMMUNITY CROSSINGS INC SAN JACINTOFACILITY NUMBER:
331880492
ADMINISTRATOR:ANDRADE, AUDREYFACILITY TYPE:
775
ADDRESS:641 N. STATE STREET #1TELEPHONE:
(951) 654-3052
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY: 60CENSUS: 42DATE:
05/17/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Priscilla Torres, Program DirectorTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a collateral visit. The purpose of the visit was to conduct interviews in regards to a matter unrelated to this facility.


There were no health and safety concerns observed during LPA's visit.

An exit interview was conducted, and copy of this report was provided to Priscilla Torres, Program Director.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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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