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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880815
Report Date: 01/07/2022
Date Signed: 01/07/2022 12:47:53 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:A TENDER TOUCH SENIOR LIVING LLCFACILITY NUMBER:
331880815
ADMINISTRATOR:MOJICA, FLORENCE AFACILITY TYPE:
740
ADDRESS:1651 ROSE AVENUETELEPHONE:
(310) 532-5338
CITY:BEAUMONTSTATE: CAZIP CODE:
92223
CAPACITY:6CENSUS: 4DATE:
01/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Tara HinojosaTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to commence a health and safety check. LPA Brown identified herself and discussed the purpose of the visit with caregiver Tara Hinojosa due to complaint # 18-AS-20220106082752.

Residents in care were present during visit. No imminent health and/or safety concerns observed at the time of visit. LPA observed no health and/or safety hazards inside the facility. LPA inspected the outside perimeter of the facility and observed no health and/or safety hazards. LPA observed sufficient staff present at the facility to provide care. LPA inspected facility food supplies and observed an adequate supply of perishable and non-perishable food. The needs of the residents in care appear to be met during this inspection.

An exit interview was conducted where this report (LIC809) was discussed and provided to caregiver Hinojosa.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022
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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