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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881271
Report Date: 05/08/2024
Date Signed: 05/14/2024 04:58:45 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 05/14/2024 04:58 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BLESS RESIDENTIAL CARE, LLCFACILITY NUMBER:
331881271
ADMINISTRATOR/
DIRECTOR:		OBI, BLESSINGFACILITY TYPE:
735
ADDRESS:1956 TUDOR DRIVETELEPHONE:
(951) 392-3814
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY: 4CENSUS: 0DATE:
05/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:04 PM
MET WITH:Licensing Representative UnavaibleTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit and observed the screen door was open at the home. LPA walked up to the front gate and when LPA unlatched it, a young male came out of the home LPA announced herself. LPA was informed and observed a family of (5) was residing in the home. LPA was informed that they were renting the home.

LPA requested to do a brief walk through of the home, LPA observed (5) bedrooms in the home. LPA conducted a walk through and observed no residents in care. LPA contacted the phone numbers provided on the facility profile. LPA left a voicemail for (619) 694-0971. (951) 392-3814 stated it was out of service.

This report will be mailed to the licensee's mailing address.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 05/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/08/2024
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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