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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412341
Report Date: 08/08/2023
Date Signed: 08/08/2023 11:11:51 AM

Document Has Been Signed on 08/08/2023 11:11 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:MAYBERRY HOUSE, THEFACILITY NUMBER:
336412341
ADMINISTRATOR:DEBORAH STANGELFACILITY TYPE:
735
ADDRESS:40678 MAYBERRY AVETELEPHONE:
(951) 652-3556
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY: 4CENSUS: 3DATE:
08/08/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee Deobrah Stangel, Veda Hervey, Shanay WatersTIME COMPLETED:
11:15 AM
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On today's date an informal meeting was held with Licensing Program Analyst (LPA) Javina George and Licensing Program Manager (LPM) Joel Esquivel met with the Licensee Deobrah Stangel, Facility Administrator Veda Hervey and Shanay Waters, General Manager. The following issues were discussed:

-Substantiated complaint findings
-The resident's and their personal rights

Moving forward the licensee stated that they have met with staff and residents to reinforce and reiterate the aspects of personal rights as it relates with food and behavior modification.

An exit interview was conducted and a copy of this report was reviewed and provided to Deborah Stangel, Licensee.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2023
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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