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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412425
Report Date: 05/20/2024
Date Signed: 05/20/2024 09:36:28 AM


Document Has Been Signed on 05/20/2024 09:36 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: 19DATE:
05/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Eufemia Cacdac, AdministratorTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to conduct a health and safety check following receipt of information regarding the Licensee not having an active governing body.

The LPA toured the interior and exterior areas of the facility with Administrator Cacdac. The LPA observed the utilities in each of the three buildings to be working; the call system, smoke and carbon monoxide detectors were operational, and the required minimum supply of food was available. The LPA observed the door to the medication room to be unlocked. No residents were in the immediate area. An advisory notice will be issued.

No immediate health and safety concerns were observed during the visit. The Licensee representative, Edgardo Roces, was contacted and notified of the LPA's visit. He informed the LPA he had not submitted the weekly email update relating to his efforts to get the LLC back into an active status, as agreed upon during an informal meeting on 05/06/2024. He stated he would provide the update today, 05/20/2024.

This report was reviewed with Administrator Cacdac and a copy was provided.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie MartinezTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2024
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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