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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881093
Report Date: 05/17/2022
Date Signed: 05/17/2022 11:22:10 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/17/2022 11:22 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:REGENT RESIDENTIAL CARE, THEFACILITY NUMBER:
331881093
ADMINISTRATOR:OCAMPO, SHANEFACILITY TYPE:
740
ADDRESS:24939 SUNSET VISTA AVENUETELEPHONE:
(951) 775-0959
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY:6CENSUS: 0DATE:
05/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Licensee- Josphine CaparanoTIME COMPLETED:
11:25 AM
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Licensing Program Analyst (LPA), Janira Arreola visited the facility on 5/16/2022 and attempted to conducted an annual inspection at the facility. LPA contacted Licensees Shame Ocampo and Josephine Caparano and was told that no one was at the home to grant entry. LPA returned to the facility 5/17/2022 and was granted entry by licensee Josephine Caparano, who was informed of the purpose of the visit.

LPA toured the facility and observed no residents. The facility is has 4 bedrooms and 3 bathrooms. All bedrooms have furniture such as a bed, desk lamp, chair, night stand and closet space. All bathrooms are fully stocked with toilet paper, soap, and paper towels. The kitchen was clean and stocked with food, cooking pans and pots, and utensils. The living room and dinning area have enough seating for the capacity of the facility which is for (6) residents. The outdoor area is clean and free of hazards and has a shaded seating area for more than (6).

LPA was informed by Licensee Josephone Caparano on 5/16/2022 that her and Licensee Shane Ocampo have in interest in closing the facility. LPA verified on this visit that the facility currently has no residents. LPA requested that a letter of these intentions be submitted to the department and for the Facility license to be mailed into the department.

There were no deficiencies cited at the time of the visit. This report was reviewed and a copy was given to Licensee Josphine Caparano.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2022
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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