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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336410287
Report Date: 03/20/2023
Date Signed: 03/20/2023 11:58:06 AM


Document Has Been Signed on 03/20/2023 11:58 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:SENIOR HOME PROFESSIONAL CARE IIFACILITY NUMBER:
336410287
ADMINISTRATOR:SARAH EVANGELISTAFACILITY TYPE:
740
ADDRESS:45155 DESERT AIRTELEPHONE:
(760) 772-2948
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY:6CENSUS: 0DATE:
03/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Sarah Evangelista, LicenseeTIME COMPLETED:
12:05 PM
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On March 20, 2023, Licensing Program Analyst (LPA), Chinwe Nwogene, made an unannounced visit to the facility to conduct the annual inspection. LPA met with Licensee, Sarah Evangelista who was informed of the purpose of the visit. Sarah informed LPA no clients are currently residing in the facility. According to Licensee, the last client moved out on 12/6/2022 and the house is currently up for sale.

LPA, accompanied by Sarah, toured the interior and exterior areas of the facility, including the garage and storage spaces. No clients or belongings of clients were observed at time of visit. The LPA informed Sarah that the license is no longer valid as of 3/20/2023. She was notified care and supervision could not be provided to any individuals at this location unless licensure was pursued in the future. Sarah verbalized her understanding and stated the original license has already been mail to the Department in January 2023.

No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed with and provided to Sarah Evangelista.

SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2023
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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