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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336410270
Report Date: 12/15/2022
Date Signed: 12/15/2022 03:58:54 PM


Document Has Been Signed on 12/15/2022 03:58 PM - 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:CHRISTMAS COTTAGEFACILITY NUMBER:
336410270
ADMINISTRATOR:ROSALYNNE VALIENTEFACILITY TYPE:
740
ADDRESS:330 S. SAN JACINTO STTELEPHONE:
(951) 765-1840
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY:14CENSUS: 15DATE:
12/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Kailene Martinez, Supervisor
Kay Hyland, Manager		TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Tricia Danielson and Licensing Program Manager(LPM) Deborah Mullen arrived unannounced to the facility to conduct a case management visit in to serve an immediate exclusion letter for staff Laura Suarez. LPA and LPM met with Supervisor Kailene Martinez and Manager Kay Hyland and explained the purpose of today's visit.

LPA and LPM informed Martinez and Hyland that the Department has determined that the presence of Laura Suarez in a facility licensed by the Department of Social Services constitutes a threat to the safety to residents in care, the Department therefore orders the facility to remove Laura Suarez. LPA and LPM did not observed Suarez at the facility during today's visit. Per Licensee Victoria Sarson, Suarez was terminated November 23, 2022. LPA and LPM informed Martinez and Hyland that Ms. Suarez had been excluded from being employed in any facility licensed by the Department of Social Services and was not permitted to return to the facility. Martinez and Hyland reported understanding of the conditions of Laura Suarez's exclusion and would not permit Suarez to return to the facility.

An exit interview was conducted and a copy of this report was provided to Martinez and Hyland.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:
DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/15/2022
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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