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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881372
Report Date: 10/18/2024
Date Signed: 10/18/2024 03:29:02 PM

Document Has Been Signed on 10/18/2024 03:29 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:SEGOVIA OF PALM DESERTFACILITY NUMBER:
331881372
ADMINISTRATOR/
DIRECTOR:		SALVADOR JIMENEZFACILITY TYPE:
741
ADDRESS:39905 VIA SCENATELEPHONE:
(760) 674-3200
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY: 182CENSUS: 154DATE:
10/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:40 PM
MET WITH:Alishia Perez, asst. exe. directorTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analysts (LPA) Seo Jeon and Ferrer Sabarias made an unannounced visit to the facility to conduct a Case Management visit regarding an incident that took place on 7-14-2024. LPA spoke with Alishia Perez, Assistant Executive Director and obtained the information. LPA found no health and safety issues at this time.

There are no deficiencies being cited, per California Health & Safety Code and Code of Regulations, Title 22.
An exit interview was conducted, a copy of this report was provided to the Assistant Executive Director, Alishia Perez.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2024
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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