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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881128
Report Date: 03/08/2021
Date Signed: 03/08/2021 11:22:58 AM

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:LA SIERRA GARDENSFACILITY NUMBER:
331881128
ADMINISTRATOR:CANTORIA, ROBERTFACILITY TYPE:
740
ADDRESS:4846 DOANE AVE.TELEPHONE:
(951) 376-1361
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:12CENSUS: 4DATE:
03/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:56 AM
MET WITH:Robert CantoriaTIME COMPLETED:
11:27 AM
NARRATIVE
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Licensing Program Analyst (LPA) Natalie Gayoso conducted an unannounced case management visit to the facility. LPA initially met with caregiver Gino Alvarez. The administrator Robert Cantoria arrived during the visit. LPA discussed the purpose of todays visit with Administrator

The Department was informed regarding allegations of possible physical abuse of residents. LPA toured the facility and interviewed staff,residents, and administrator.

LPA also conducted a Health & Safety Check of the facility. LPA toured the inside and outside of facility. LPA observed here was a sufficient amount of staff present at the facility to provide care for clients. LPA inspected facility food supplies and observed an adequate supply of perishable and non-perishable food and utilities are working. The needs of the residents in care appear to be met during the inspection. LPA did not observe any imminent health & safety concerns.

An exit interview was conducted where this report was discussed and provided to the Administrator
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie GayosoTELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2021
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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