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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336410306
Report Date: 12/18/2020
Date Signed: 12/18/2020 03:53:17 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:PROVIDENCE RESIDENTIAL CARE IIFACILITY NUMBER:
336410306
ADMINISTRATOR:JOSE L ARBOLEDAFACILITY TYPE:
740
ADDRESS:23595 TAFT COURTTELEPHONE:
(951) 813-3133
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:6CENSUS: 3DATE:
12/18/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Leonisa PanilagTIME COMPLETED:
04:10 PM
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LPA Susan Parker conducted a Case Management visit/Health & Safety check, due to the fact that this facility is closing. LPA Parker met with caregiver Leonisa Panilag and explained the purpose of the visit. Ms. Panilag called the licensee, Jose Arboleda and LPA spoke with him. Mr. Arboleda said the house was sold and escrow closed on 11/13/20. Mr. Arboleda said someone is helping him find places for the 3 residents to live.

LPA Parker toured the facility and observed the following: Living room, kitchen, family room, 4 resident bedrooms, a staff room, 2 bathrooms, laundry room, front and back yards. The rooms are clean and LPA did not observe any safety hazards. LPA observed perishable and non-perishable foods. LPA Parker interviewed all 3 residents and they said they are eating 3 meals per day and they are receiving their medications. They said they are comfortable. The water, electricity and heat are working.

Residents #1 and #2 said they have found a place to live and they will be moving out on 12/28/20. Resident #3 said someone is working with him to find a place to live. The person has located a place and resident #3's family will help with making the decision to move there or not.

Jose Arboleda said he understands he is responsible for the operation of this facility until all residents have been relocated. The caregiver lives in the facility and is here providing care and supervision to the 3 residents. LPA Parker did not cite any deficiencies today.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Susan ParkerTELEPHONE: (951) 897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2020
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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