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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336411357
Report Date: 02/28/2024
Date Signed: 02/28/2024 04:53:27 PM

Document Has Been Signed on 02/28/2024 04:53 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:SLB INC CALLE PRIMAFACILITY NUMBER:
336411357
ADMINISTRATOR:COTADELA BALATBATFACILITY TYPE:
735
ADDRESS:21650 CALLE PRIMATELEPHONE:
(951) 776-0424
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 6CENSUS: 6DATE:
02/28/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
04:01 PM
MET WITH:ADMINISTRATOR, COTADELA BALATBATTIME COMPLETED:
04:55 PM
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On February 28, 2024, Licensing Program Analyst (LPA), Venus Mixson
conducted an unannounced collateral visit to the facility for an unrelated matter to the facility. The collateral visit was conducted to conduct observations, interviews and records reviews pertaining to another matter.

The LPA met with the Administrator, Cotadela Balatbat, introduced herself and stated the purpose of the visit. LPA Mixson toured the facility along, with the Administrator and made observations relating to another matter altogether.

There were no health and safety concerns or issues observed during the time of this visit. Currently at the facility there are three staff and the Administrator, and six residents. The facility was clean and well maintained there were no obstructions to the inside or outside passageways. LPA Mixson reviewed several resident files and made observations to the other matter being investigated. LPA Mixson reviewed the daily notes that are written by the staff every day. There were no reviewed concerns or issues with injuries or pain reported or observed by the SLB Calle Prima staff. LPA Mixson requested and received pertinent documentation.

An exit interview was conducted a copy of this report was provided to the Administrator, Cotadela Balatbat.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
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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