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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336408867
Report Date: 09/19/2024
Date Signed: 09/20/2024 08:07:49 AM

Document Has Been Signed on 09/20/2024 08:07 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:HOMESTEAD HAVENFACILITY NUMBER:
336408867
ADMINISTRATOR/
DIRECTOR:		VICTOR UGARTEFACILITY TYPE:
735
ADDRESS:14307 HOMESTEAD DRIVETELEPHONE:
(951) 707-3906
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 6CENSUS: 0DATE:
09/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
09:00 AM
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Licensing Program Analyst (LPA) Valerie Flores attempted to conduct an unannounced 1-year required visit. LPA called Licensee Victor Ugarte with no success. Several voicemail's have been left to try to reach the applicant.

LPA observed in the front yard a broken mailbox laying on the ground, a garbage can filled with old wood, overgrown grass, the front door is being covered by a piece of fence and wood, and the front window broken and boarded up. LPA peered into the broken window and observed the home to be empty. No furniture, lighting or decorations were observed. The home appeared to be abandoned.

LPA attempt to make contact with Licensee and return at a later date.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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