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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880592
Report Date: 04/19/2022
Date Signed: 04/19/2022 10:56:26 AM


Document Has Been Signed on 04/19/2022 10:56 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:AVENIDA CARE VILLAFACILITY NUMBER:
331880592
ADMINISTRATOR:MARTINEZ, VILMAFACILITY TYPE:
740
ADDRESS:20332 AVENIDA HACIENDATELEPHONE:
(951) 807-3304
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY:6CENSUS: 0DATE:
04/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Glorimar Cole, LicenseeTIME COMPLETED:
11:00 AM
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Licensing Program Analysts (LPAs), Stephanie Torres and Chinwe Nwogene, made an unannounced visit to the facility to conduct the annual inspection. The LPAs me with Licensee, Glorimar Cole, and informed her of the purpose of their visit. Per Cole no residents are currently in care.

No COVID-19 mitigation measures are currently in place. Cole stated the Plan for Epidemic Outbreak Specific to COVID-19 Mitigation Plan Report will be reviewed and other mitigation measures will be put in place prior to any residents being admitted to the facility. No immediate health and safety concerns were observed at time of visit.

This report was reviewed with Cole and a copy was provided.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2022
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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