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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412425
Report Date: 05/06/2024
Date Signed: 05/06/2024 10:18:45 AM


Document Has Been Signed on 05/06/2024 10:18 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:WINTER WOODS COTTAGESFACILITY NUMBER:
336412425
ADMINISTRATOR:EUFEMIA CACDACFACILITY TYPE:
740
ADDRESS:845 W. LA CADENA DRIVETELEPHONE:
(951) 682-4198
CITY:RIVERSIDESTATE: CAZIP CODE:
92501
CAPACITY:23CENSUS: 18DATE:
05/06/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Edgardo Roces, LicenseeTIME COMPLETED:
10:30 AM
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On May 06, 2024, Community Care Licensing (CCLD) held an informal meeting conducted in the Riverside Adult and Senior Care Regional Office. In attendance was Licensing Program Manager (LPM) Rikesha Stamps, Licensing Program Analysts (LPAs) Stephanie Martinez, Valerie Flores, Seo Jeon and Licensee Representative, Edgardo Roces.

The purpose of the meeting is to discuss the inactive status governing body of Winter Woods Home Care for Elderly LLC, operating as Winter Woods Cottages. During today’s meeting Licensee Roces confirmed with the CCLD that the governing body of Winter Woods Home Care for Elderly LLC is inactive and a date of reinstatement is unknown at this time. He reported taxes would have to be filed for the years 2006, 2021, 2022, and 2023. He reported the annual taxes are expected to be filed within one month from today. He reported he needs to follow up on tax years from 2021 - 2023, and 2006. In addition, form 3557 (Application for Certificate for Revivor - Corporation) has to be completed and submitted to the Franchise Tax Board for consideration of lifting the suspension. He submitted proof of fees paid that accrued for late fee penalties and failure to file taxes. He agreed to check in with the Department weekly to provide a status update. He stated the 2021 taxes will be filed on 05/08/2024.

During the meeting, the amendment of citation 87205(b) issued on 04/04/2024, relating to Accountability of Licensee Governing Body was completed. The Plan of Correction (POC) was clarified and the new date of submission is 06/06/2024.

Licensee was provided resources from the CCLD transparency website and was encouraged to adhere to the Title 22 Regulations on maintaining substantial compliance. An exit interview was conducted with Licensee Roces and was provided a copy of this report.

SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie MartinezTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/06/2024
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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