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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881377
Report Date: 07/20/2023
Date Signed: 07/20/2023 09:30:54 AM

Document Has Been Signed on 07/20/2023 09:30 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:QUALITY CARE ONE LLCFACILITY NUMBER:
331881377
ADMINISTRATOR:LEE, DANIELLEFACILITY TYPE:
735
ADDRESS:24021 PUDDINGSTONE DRTELEPHONE:
(323) 551-7326
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92551
CAPACITY: 2CENSUS: 0DATE:
07/20/2023
TYPE OF VISIT:POCANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Applicant Danielle Lee TIME COMPLETED:
09:45 AM
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On Thursday, 7/20/2023, Licensing Program Analyst (LPA) Janette Romero conducted an announced visit to the pending facility for a proof of corrections inspection. LPA met with Applicant Danielle Lee.

LPA observed the following corrections:

Non-slip mat provided in client shower

Replacement of self-closing gate latch

Outside passageways cleared and free from obstructions

Hot water temperature in client bathroom adjusted to 105.9 degrees Fahrenheit

LPA will notify CAB analyst of proof of corrections upon return to the office.

An exit interview was conducted where a copy of this report was discussed and provided to Applicant Lee.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2023
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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