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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881329
Report Date: 08/08/2023
Date Signed: 08/08/2023 02:43:30 PM


Document Has Been Signed on 08/08/2023 02:43 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:CARLOTTA, THEFACILITY NUMBER:
331881329
ADMINISTRATOR:BOWIE, MOLLYFACILITY TYPE:
741
ADDRESS:41-505 CARLOTTA DRIVETELEPHONE:
(760) 346-5420
CITY:PALM DESERTSTATE: CAZIP CODE:
92211
CAPACITY:250CENSUS: 37DATE:
08/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Executive Director, Monica GuerraTIME COMPLETED:
02:50 PM
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On 8/8/2023, Licensing Program Analyst (LPA), Chinwe Nwogene conducted a case management visit in conjunction with complaint number 18-AS-20230215163750. LPA met with Executive Director, Monica Guerra who was informed of the purpose of the visit.

During today's visit, LPA interviewed staff. LPA requested to review residents file but was informed that resident file is currently unavailable. Monica stated the facility is under new management that took effect 4/1/2023. Monica stated resident’s file will be requested from the old management and LPA will be notified when file becomes available. No citation will be issued during today’s visit.

An exit interview was conducted were this report was discussed with and provided to Monica Guerra.

SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2023
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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