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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880809
Report Date: 08/28/2024
Date Signed: 08/28/2024 08:47:41 AM


Document Has Been Signed on 08/28/2024 08:47 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
RIVERSIDE ASC, 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: 4DATE:
08/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:03 AM
MET WITH:Jeanella Aliviado, StaffTIME COMPLETED:
08:50 AM
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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to follow up on the closure of the facility. The LPA met with staff, Jeanella Aliviado, and informed her of the purpose for the visit. Aurora Cuasay, the applicant of the currently operating facility, Amazing Angels Care Facility, was notified of the purpose for the visit. Amazing Angels is currently pending a license approval.

The LPA toured the facility and observed four residents in care. The LPA did not observed any immediate concerns during the visit. The LPA obtained a copy of the resident roster and spoke with staff about the current location of previous residents. According to applicant Cuasay, all residents remained in the facility during the ownership transfer.

This report was reviewed with staff Aliviado and a copy was provided.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie MartinezTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2024
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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