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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881420
Report Date: 08/31/2023
Date Signed: 08/31/2023 02:52:44 PM


Document Has Been Signed on 08/31/2023 02:52 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:PENDA HOMES ASSISTED LIVINGFACILITY NUMBER:
331881420
ADMINISTRATOR:KIMINYEI, MILDREDFACILITY TYPE:
740
ADDRESS:26042 WESTRIDGE AVENUETELEPHONE:
(619) 483-6656
CITY:MENIFEESTATE: CAZIP CODE:
92586
CAPACITY:3CENSUS: 2DATE:
08/31/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:27 PM
MET WITH:Joseph Sang, Administrator Asst.TIME COMPLETED:
02:55 PM
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Licensing Program Analyst (LPA) Yolanda Delgado made an unannounced visit to the facility to verify pending increased capacity from three (3) to six (6). LPA was greeted at the door by Joseph Sang and was informed of the purpose of the visit and was allowed entry. Administrator was called by staff to notify about LPA's visit. LPA verified bedroom #1 has two beds, furniture, bedding, two chairs and closet space, bedroom #4 has two beds, bedding, two chairs, closet space and a bathroom. There is space in each room for two clients to share bedroom. There were two staff on duty. LPA verified status with LPM Harris. Two other rooms were private.

There were no deficiencies and no civil penalties that were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted with Sang and a copy of this report was provided.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda DelgadoTELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023
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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