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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336402019
Report Date: 11/19/2024
Date Signed: 11/19/2024 10:48:08 AM

Document Has Been Signed on 11/19/2024 10:48 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:EUGENIA'S SWEET HOME CAREFACILITY NUMBER:
336402019
ADMINISTRATOR/
DIRECTOR:		GRISELDA GARCIAFACILITY TYPE:
740
ADDRESS:264 EAST SECOND STREETTELEPHONE:
(951) 654-1325
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
11/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Mikayla Valdez, house mangerTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On 11-19-2024, Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit for the purpose of the facility's closure. LPA met with Mikayla Valdez, house manager, to tour the facility.

CCLD learned of the facility's closure on 11-04-2024 from the facility's administrator, Bianca Costin, who contacted the Department and informed the facility's plan to close on 12-01-2024 via email. Bianca Constin informed that the facility is closing due to licensee's retirement.

During today's visit, LPA toured the interior and exterior of facility with house manager, Mikayla Valdez, and did not find any health and safety issues. There were four (4) residents in care. LPA reviewed 4 resident and 2 staff files. LPA conducted interview with one resident. LPA reviewed resident roster showing the dates and facilities of all 4 residents were relocating to. LPA reviewed medication records for two (2) residents and the records showed all medications were dispensed correctly.

The facility surrendered their original License today, 11-19-2024. The LPA explained to house manager that the license will no longer be valid, and therefore no required care and supervision should be provided in the home unless the state approves licensure in the future.

An exit interview was conducted, and a copy of this report was provided to the house manager, Mikayla Valdez.
Rikesha StampsTELEPHONE: (951) 212-0616
Seo JeonTELEPHONE: 951-248-0309
DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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