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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336410303
Report Date: 09/06/2024
Date Signed: 09/06/2024 08:45:37 AM


Document Has Been Signed on 09/06/2024 08:45 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:SIMCARE HOMES LLCFACILITY NUMBER:
336410303
ADMINISTRATOR:PERLITA SIMANFACILITY TYPE:
740
ADDRESS:155 BRACEBRIDGE ROADTELEPHONE:
(951) 429-7142
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:6CENSUS: 0DATE:
09/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:27 AM
MET WITH:Perlita and Willfredo Siman, LicenseesTIME COMPLETED:
08:45 AM
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Licensing Program Analyst (LPA) Yolanda Delgado made an unannounced visit to conduct a facility closure. CCLD received a letter from Wilfredo Siman effective September 1, 2024 Simcare Homes LLC #336410303 will be closing. The last resident was relocated this past weekend. Perlita and Wilfredo Siman stated they sold the home in 2023 and LPA is unable to conduct a walk-through to obtain the license and to review resident files as the Licensee no longer have access to the facility and does not have the resident files.

LPA Delgado requested Licensee to provide a resident roster, the relocation of residents along with their responsibility parties information and will need to be submitted to LPA by Friday, September 13, 2024.

There were no deficiencies and no civil penalties that were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted with Perlita and Wilfredo Siman and a copy of this report was provided.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda DelgadoTELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2024
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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