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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880967
Report Date: 03/13/2025
Date Signed: 03/13/2025 02:44:16 PM

Document Has Been Signed on 03/13/2025 02:44 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:GARDEN OF EDEN CARE HOMEFACILITY NUMBER:
331880967
ADMINISTRATOR/
DIRECTOR:		HOLMES-OTTO, REGINAFACILITY TYPE:
740
ADDRESS:31241 CASERA COURTTELEPHONE:
(951) 388-6204
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY: 6CENSUS: 1DATE:
03/13/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Licensee/ Administrator Regina Holmes-Otto TIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On March 13, 2025, Licensing Program Analyst (LPA), Kathleen Banrasavong made an unannounced visit for the purpose of the facility's closure and met with Licensee/ Administrator, Regina Holmes-Otto.

The Licensee is initiating this closure on 03/08/2025 with effective date of closure 04/21/2025. LPA Banrasavong was able to inspect the facility inside. Licensee stated there was one (1) Resident 1 (R1) and R1 would be safely relocated by the family by the date of 04/21/2025. Licensee stated the reason for closure was due to personal reasons.

The LPA indicted that the closure would not be effective until R1 was relocated. The Licensee stated that she will contact the LPA to arrange a day to surrender a copy of the License (Effective Date: 10/09/2020), with a Facility Number 331880967, Total Capacity: 6. She stated that she will let the LPA once the R1 has been relocated.

No further information.

An exit interview was conducted with the Licensee and a copy of this report was provided.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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