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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880809
Report Date: 12/03/2021
Date Signed: 12/03/2021 01:50:31 PM

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:ABOUNDING GRACE CARE HOME, INC.FACILITY NUMBER:
331880809
ADMINISTRATOR:DELA CRUZ, CHERYLFACILITY TYPE:
740
ADDRESS:26152 WINDEMERE WAYTELEPHONE:
(951) 961-1303
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:6CENSUS: DATE:
12/03/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cheryl Dela Cruz & Aurora CausayTIME COMPLETED:
11:00 AM
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An Informal Meeting was conducted today via Zoom due to COVID-19 in order to discuss recent concerns and facility's operation. Persons present at today’s meeting were: Licensing Program Manager (LPM) Joel Esquivel, Licensing Program Analyst (LPA) Crystal Colvin, Licensing Program Analyst (LPA) Venus Mixon and Licensee/Administrator Cheryl Dela Cruz, and staff member/new applicant Aurora Causay.

Below are the topics that were addressed during the Informal Meeting tele-visit:
  • Serious deficiencies issued on 11/17/21

  • Outstanding Plan of Corrections - 87465(e)(1) & 87464(f)(4)

  • Change of Ownership application & responsibility of current licensee

  • Administrator's work hours & involvement in the facility



LPM Joel Esquivel and LPA Crystal Colvin offered Licensee Cheryl Dela Cruz the Technical Support Program (TSP) Assistance. The Licensee accepted the TSP Program and LPA Colvin will be making a referral to TSP on their behalf.

An exit interview was conducted and a copy of this report was provided via email to Licensee Cheryl Dela Cruz for signature.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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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