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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336410274
Report Date: 12/09/2020
Date Signed: 12/09/2020 04:36:51 PM

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:
336410274
ADMINISTRATOR:VICTORIA J. SARSONFACILITY TYPE:
740
ADDRESS:320 S. SAN JACINTO STTELEPHONE:
(951) 765-1840
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY:17CENSUS: 16DATE:
12/09/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Licensee, Victoria Sarson TIME COMPLETED:
04:29 PM
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Due to the Department’s implementation, and in following current public health guidance, this report will be delivered via telephone. Licensing Program Analyst (LPA) David Cuevas contacted the facility to conduct a case management visit via telephone due to the COVID-19 restrictions. LPA identified self and discussed the purpose of the call with Licensee/Administrator Victoria Sarson.

LPA discussed the purpose of the case management visit is to confirm that an individual with a non-exemptible conviction is not present or working in the facility. Based on evidence obtained during today's visit, the LPA has verified the individual is not present, employed, or residing at the facility. The individual named in the Confirmation of Removal Letter dated 11/17/2020 is Christina Crowell. During the visit, the LPA reviewed the facility's staff roster and separation of employment documents to verify that the individual is not working at the facility. Licensee has illed out the Confirmation of Removal form to confirm that Christina Crowell is not working in the facility.

Verification of removal is complete. An exit interview was conducted via telephone where this report (LIC 809) was discussed and a copy was provided to Licensee, Victoria Sarson via email.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: David CuevasTELEPHONE: (951) 295-3927
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2020
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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