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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881285
Report Date: 08/21/2024
Date Signed: 08/21/2024 10:36:20 AM


Document Has Been Signed on 08/21/2024 10:36 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:BETTY'S PLACEFACILITY NUMBER:
331881285
ADMINISTRATOR:ARDIE CRENSHAWFACILITY TYPE:
740
ADDRESS:37182 SIERRA GROVE DRIVETELEPHONE:
(951) 316-1549
CITY:MURIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 5DATE:
08/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:House Manager, Floretta CrenshawTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced case management visit to the facility. LPA met with Floretta Crenshaw, who identified herself as the House Manager for the facility. The visit is in response to information obtained by the department of a possible transfer of the facility. During the time of the visit there were (3) staff and (4) residents present.

LPA conducted a tour of the facility, interviewed staff and residents, and conducted file reviews for residents and staff. LPA verified background clearance for the staff present during the time of the visit on the Guardian system. No immediate health and safety concerns were observed during the visit. LPA observed resident in their rooms and common areas of the facility and staff conducting checks and residents and cleaning of the facility.

No deficiencies were cited at the time of the visit. An exit interview was conducted with the House Manager where this report was reviewed and provided to them.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:
DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/21/2024
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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