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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336406381
Report Date: 03/11/2021
Date Signed: 03/22/2021 11:45:58 AM

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:LAJOYA DE LA REINAFACILITY NUMBER:
336406381
ADMINISTRATOR:DIANE L EMERSONFACILITY TYPE:
740
ADDRESS:330 SANDALWOOD DRIVETELEPHONE:
(909) 446-0944
CITY:CALIMESASTATE: CAZIP CODE:
92320
CAPACITY:6CENSUS: 0DATE:
03/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Diane EmersonTIME COMPLETED:
03:46 PM
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Licensing Program Analyst (LPA) Jennifer Semin contacted the licensee Diane Emerson via telephone to verify closure of the facility. Licensee no longer has control of this property so a tour was not possible. All residents have been relocated to a licensed facility.

LPA asked Ms. Emerson to mail in/surrender her license by mailing it into 1650 Spruce St. Suite. 200 Riverside CA 92507 or to drop off when LPA is in the office. Ms. Emerson stated that she would mail the license to LPA on 3/15/2021.

The facility is closed as of today's date 3/11/2021.

An exit interview was conducted with the administrator via telephone and a copy of this report was provided via email




SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Jennifer SeminTELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2021
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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