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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881236
Report Date: 12/31/2024
Date Signed: 12/31/2024 11:28:57 AM

Document Has Been Signed on 12/31/2024 11:28 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:PARKER'S PALACE RESIDENTIALFACILITY NUMBER:
331881236
ADMINISTRATOR/
DIRECTOR:		PARKER, GREGORYFACILITY TYPE:
735
ADDRESS:21790 CALLE MONACOTELEPHONE:
(951) 212-9218
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 4CENSUS: 2DATE:
12/31/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Rachelle Parker-AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:40 PM
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Licensing Program Analyst (LPA) Debbie Palacios made an unannounced visit to conduct a case management visit for Client 1 (C1)’s death. LPA conducted a health and safety check and met Program Administrator, Rachelle Parker and Administrator Amarilys Vainez and explained the purpose of today’s visit. At the time of the LPA’s visit, there was 2 (two) clients at the facility and 3 (three) staff members present at the time of the visit.

During the LPA’s visit, LPA reviewed, requested, and obtained copies of pertinent documentation, conducted staff interview with staff member 1 (S1) regarding C1’s death on 12/23/24. LPA interviewed to obtained further information regarding the death of C1 and the events that led up to C1’s death. The cause of death is pending at this time; however, staff reported that C1 was on hospice due to heart failure. LPA advised Administrator, Rachelle Parker to send a copy of the death certificate to the department, as soon as it becomes available. Administrator stated that the POA will be receiving the death certificate.

No deficiencies were cited during this visit, as there were no health and safety concerns observed during today's visit.

An exit interview was conducted and a copy of this report (LIC 809) and LIC 811 (confidential names list) were provided.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE: DATE: 12/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/31/2024
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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