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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881196
Report Date: 03/29/2023
Date Signed: 03/29/2023 04:02:09 PM

Document Has Been Signed on 03/29/2023 04:02 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ALMA'S HOME CARE 1FACILITY NUMBER:
331881196
ADMINISTRATOR:NATIVIDAD, ALMA E.FACILITY TYPE:
735
ADDRESS:1901 EL NIDO AVENUETELEPHONE:
(318) 229-3108
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY: 4CENSUS: 3DATE:
03/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Alma Natividad, Administrator TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Yolanda Delgado arrived to the facility unannounced to conduct a Case Management visit to obtain documentation. LPA was greeted at the door by Roderick Natividad, DSP at the facility and LPA was allowed entry into the facility. Currently there are two (2) clients at the facility, one (1) client at Program and one (1) staff present. Documentation was reviewed and scanned. Administrator Alma Natividad arrived during the end of the visit.


No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed with and will be provided to Alma Natividad.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023
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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