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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336408203
Report Date: 01/28/2025
Date Signed: 01/28/2025 11:12:49 AM

Document Has Been Signed on 01/28/2025 11:12 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:TENDER LOVING CARE ASSISTED LIVINGFACILITY NUMBER:
336408203
ADMINISTRATOR/
DIRECTOR:		MARIA KRAWCZYKFACILITY TYPE:
740
ADDRESS:30595 AVENIDA DEL PADRETELEPHONE:
(760) 324-0466
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY: 6CENSUS: 1DATE:
01/28/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Maria Krawczyk, licenseeTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Seo Jeon made an unannounced visit to the facility to conduct a Case Management visit regarding an incident that took place on October 2, 2024. LPA spoke with Maria Krawczyk and obtained pertinent documentation. LPA inspected the interior and exterior areas of the home. There were no health and safety concern at the time of inspection.

There are no deficiencies being cited, per California Health & Safety Code and Code of Regulations, Title 22.
An exit interview was conducted, a copy of this report were provided to Maria Krawczyk.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE: DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/28/2025
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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