<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846109
Report Date: 03/06/2023
Date Signed: 03/06/2023 12:05:56 PM

Document Has Been Signed on 03/06/2023 12:05 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:TRF ALL SAINTSFACILITY NUMBER:
334846109
ADMINISTRATOR:MOSLEY, DR. KEENA RUSHFACILITY TYPE:
830
ADDRESS:3847 TERRACINA DRIVETELEPHONE:
(310) 420-1025
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY: 32TOTAL ENROLLED CHILDREN: 32CENSUS: 22DATE:
03/06/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Danette MejicoTIME COMPLETED:
12:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/06/2023 a case management visit was completed by Licensing Program Analysts (LPAs) Giselle Carbullido and Aman Sharma due to deficiencies found during the course of another inspection. 1) Personnel Requirements: Although staff were determined to be fingerprint cleared during this visit, facility did not associate 5 staff to their facility. SEE LIC 809-D for the deficiency cited.

The Director was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights.

An exit interview was conducted, a copy of this report and Notice of Site Visit was provided to the Program Director; and the LPAs observed the Notice of Site Visit form was posted by staff. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THREE YEARS.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 03/06/2023 12:05 PM - It Cannot Be Edited


Created By: Giselle Carbullido On 03/06/2023 at 11:15 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: TRF ALL SAINTS
FACILITY NUMBER: 334846109

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/07/2023
Section Cited
CCR
101216(i)(1)(2)

1
2
3
4
5
6
7
Personnel Requirements: 101216(i)(1)(2)
1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations or
(2) Request a transfer of a criminal record clearance as specified in Section 101170(f)
This reqirement was not met as evidenced by:
1
2
3
4
5
6
7
Facility Director will provide proof of association to the facility roster by 03/07/23. Fingerprint clearance verification was completed during this visit.
8
9
10
11
12
13
14
Based on record review- facility did not have 5 employees on the roster. Although fingerprint cleared the 5 employees were not associated to the facility. This is a potential health and safety risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Gilbert Sena
LICENSING EVALUATOR NAME:Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2