<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880933
Report Date: 06/24/2021
Date Signed: 09/21/2021 03:15:18 PM

COMPREHENSIVE INSPECTION
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:APPLE BLOSSOM RANCH ASSISTED LIVINGFACILITY NUMBER:
331880933
ADMINISTRATOR:REYNOLDS, JEREMYFACILITY TYPE:
740
ADDRESS:15651 CECIL AVE.TELEPHONE:
(951) 505-6058
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY:6CENSUS: 0DATE:
06/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:TIME COMPLETED:
10:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA Javier Prieto arrived to the facility to conduct an annual inspection. Facility gate was locked and appeared, by LPA observation through window, that facility is empty. No furniture was observed. Call made to licensee Jeremy Reynolds stated that the facility was closed and Reynolds was not able to place any clients at the facility during time of COVID pandemic, clients were never placed in the home and could no longer afford to maintain licensee or pay for residence. Reynolds stated that an email will be forwarded to LPA stating closure of facility and surrender of license.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1