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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881329
Report Date: 04/12/2023
Date Signed: 04/12/2023 12:58:30 PM


Document Has Been Signed on 04/12/2023 12:58 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:FOUNTAINS AT THE CARLOTTA, THEFACILITY NUMBER:
331881329
ADMINISTRATOR:ELLENICH, RONALDFACILITY TYPE:
741
ADDRESS:41-505 CARLOTTA DRIVETELEPHONE:
(760) 346-5420
CITY:PALM DESERTSTATE: CAZIP CODE:
92211
CAPACITY:250CENSUS: 178DATE:
04/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Executive Director, Molly BowieTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility in order to conduct a case management visit concerning an incident that happened at the facility. LPA met with the Executive Director, Molly Bowie, who was informed of the purpose of the visit.

The regional office received an SOC341 for R1 on 4/5/2023, stating that property had been allegedly stolen from R1's apartment. (1) item was identified on the SOC341, and had been reported to law enforcement.
During the visit LPA conducted interviews and reviewed facility records. LPA spoke with the Executive Director who gave the LPA a case number: #T230930087 and stated this had been reported on 4/3/2023 to law enforcement. LPA spoke with R1, who stated that in addition to the (1) item, they were also missing additional items from their apartment. LPA spoke with executive director, who was unaware of the additional items. The executive director, stated they would make a subsequent SOC341, make an inventory of the items, conduct an investigation into the whereabouts of the items, and contact law enforcement.

LPA reviewed R1's LIC602, admissions agreement, and reviewed the facility's left and lost policy signed by R1. LPA reviewed the policy and observed that the facility had followed the procedures outlined in the policy.

At the time of the visit, no other health or safety concerns were observed. No deficiencies were cited under the California Code of Regulations Title 22.

An exit interview was conducted where this report was reviewed and provided to executive director, Molly Bowie.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023
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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