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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880975
Report Date: 03/19/2021
Date Signed: 03/19/2021 12:27:48 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:OHANA HOMECARE, INC.FACILITY NUMBER:
331880975
ADMINISTRATOR:ELIZABETH RAZONFACILITY TYPE:
740
ADDRESS:69814 FATIMA WAYTELEPHONE:
(760) 832-7931
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:6CENSUS: 0DATE:
03/19/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:08 PM
MET WITH:Elizabeth Razon, AdministratorTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Tricia Danielson conducted this second pre-license visit with Administrator (AD) Elizabeth Razon. A second visit was required to verify the correction of item needed as identified during the initial pre-licensing inspection.
LPA observed the facility side gate to have a spring attached and now operates in a self latching manner.

Based on todays inspection, the item identified during the initial pre-licensing deficiency has been resolved and the pre-licensing has been completed. Final approval of licensure will be granted by the Centralized Application Bureau (CAB) analyst.

An exit interview was conducted and a copy of this report was provided via email and a read receipt confirms receipt of the report. AD has agreed to sign the report and return a signed copy to LPA.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
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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