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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880778
Report Date: 01/16/2024
Date Signed: 01/16/2024 01:43:58 PM


Document Has Been Signed on 01/16/2024 01:43 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:FAMILY FIRST RESIDENTIAL CAREFACILITY NUMBER:
331880778
ADMINISTRATOR:FLORES, NIRMLA GFACILITY TYPE:
740
ADDRESS:42299 FABER CTTELEPHONE:
(951) 252-7217
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY:6CENSUS: 0DATE:
01/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Nirmla Flores, Licensee
David Flores, Licensee 		TIME COMPLETED:
01:50 PM
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On 1/16/2024, Licensing Program Analyst (LPA), Chinwe Nwogene, made an unannounced visit to the facility to conduct the annual inspection. LPA met with Licensees, Nirmla Flores and David Flores who were informed of the purpose of the visit. Nirmla informed LPA that the facility is closed and is no longer in business. Nirmla reported the facility stopped operating at the end of 2021. Nirmla reporter that facility had one client and the client was relocated to another facility.

The LPA, accompanied by Nirmla, toured the interior and exterior areas of the facility, including the garage and storage spaces. No clients or belongings of clients were observed at time of visit. The LPA informed Nirmla that license is no longer valid as of January 16, 2024. Nirmal was notified care and supervision could not be provided to any individuals at this location unless licensure was pursued in the future. Nirmla verbalized her understanding and agreed to mail the license to the Department.

An exit interview was conducted where this report was discussed, and a copy was provided to Nirmla Flores.

SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:
DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/16/2024
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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