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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530032
Report Date: 05/04/2023
Date Signed: 05/04/2023 03:32:16 PM


Document Has Been Signed on 05/04/2023 03:32 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
, CA 92507



FACILITY NAME:VILLA DE ANZAFACILITY NUMBER:
335530032
ADMINISTRATOR:KATHERINE A. TREVINOFACILITY TYPE:
740
ADDRESS:5881 EL PALOMINO DRIVETELEPHONE:
(951) 683-3333
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:197CENSUS: 104DATE:
05/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Executive Director Patrick Lee McAdoo-MortonTIME COMPLETED:
03:30 PM
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LPA Javier Prieto arrived to the facility and met with recently appointed Executive Director Patrick Lee McAdoo-Morton. A Health and Safety visit was conducted. LPA Prieto and Morton toured the facility, visited resident rooms and spoke to residents in the common area. The facility appears to this LPA to clean and sanitized. Hallway are clean and free of any obstructions. Facility is newly decorated. Facility menus have been upgraded and new changes made to the facility in the form of upgrades to the dinning area and common area. After today's visit to the facility, LPA did not observe anything that would be of concern regarding the health and safety of the residents.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023
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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