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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336408381
Report Date: 03/29/2023
Date Signed: 04/03/2023 10:23:33 AM


Document Has Been Signed on 04/03/2023 10:23 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:ST. MARY'S LOVE AND CARE HOMEFACILITY NUMBER:
336408381
ADMINISTRATOR:JANARD LANSANGANFACILITY TYPE:
740
ADDRESS:74039 KOKOPELLI CIRCLETELEPHONE:
(760) 779-9887
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:6CENSUS: 5DATE:
03/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Philip Christian, AdministratorTIME COMPLETED:
02:35 PM
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On March 29, 2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene was greeted and granted entry by caregiver, Charito Bernardo. Charito called the administrator, Philip Christian who arrived at the facility shortly after. Charito Bernardo and Philip Christian were informed of the purpose of visit. At the time of visit there was 2 staff and 5 residents present.

LPA toured the facility inside and out with Philip and Charito. Tour included Kitchen, Dining, Livingroom, hallway, laundry, bathrooms, resident bedrooms, staff room, laundry room, garage, and backyard. Due to insufficient time, a return visit will be conducted to continue the inspection.

An exit interview was conducted, and a copy of this report was reviewed with and provided to Philip Christian.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2023
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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