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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881475
Report Date: 12/20/2024
Date Signed: 12/20/2024 02:21:04 PM

Document Has Been Signed on 12/20/2024 02:21 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:CARMELITE ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
331881475
ADMINISTRATOR/
DIRECTOR:		ROSANA, BIENVENIDOFACILITY TYPE:
735
ADDRESS:245 E SIXTH STREETTELEPHONE:
(562) 453-9838
CITY:SAN JACITOSTATE: CAZIP CODE:
92583
CAPACITY: 58CENSUS: 23DATE:
12/20/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:38 PM
MET WITH:Licensee and Administrator, Bienvenido RosanaTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced collateral visit to meet with Licensee and Administrator, Bienvenido Rosana for an unrelated matter. LPA identified herself and the purpose of the visit. LPA conducted a walk through during the time of the visit. No deficiencies were cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 12/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/20/2024
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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