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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881196
Report Date: 05/11/2023
Date Signed: 05/11/2023 04:36:26 PM

Document Has Been Signed on 05/11/2023 04:36 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:
05/11/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Caregiver Edna CabrerosTIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a Collateral visit. The purpose of the visit was to conduct an interview with Client #1 (C1) in regards to an open complaint not related/associated with this facility.

LPA was greeted and granted entry by Caregiver Edna Cabreros, where explained the purpose of her visit. The Administrator was available via telephone.

No heath and safety concerns were observed at the time of LPAs visit.

An exit interview was conducted, and a copy of this report was reviewed and provided to Caregiver Edna Cabreros.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2023
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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