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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880492
Report Date: 07/15/2024
Date Signed: 07/15/2024 03:12:16 PM

Document Has Been Signed on 07/15/2024 03:12 PM - 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/
DIRECTOR:		ANDRADE, AUDREYFACILITY TYPE:
775
ADDRESS:641 N. STATE STREET #1TELEPHONE:
(951) 654-3052
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY: 60CENSUS: 49DATE:
07/15/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Priscilla Torres, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Yolanda Delgado made an unannounced visit to the facility to clear deficiencies cited on 07/12/2024. LPA was greeted by Program Director, Priscilla Torres and explained the reason for the visit. Citations were corrected and cleared. Two staff were present with one client awaiting to be picked up from Program.

No health and safety concerns were observed during today's visit.

An exit interview was conducted, and a copy of this report was provided to Program Director, Priscilla Torres.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2024
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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