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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423741
Report Date: 01/11/2023
Date Signed: 01/11/2023 11:42:40 AM

Document Has Been Signed on 01/11/2023 11:42 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:SVS-PALM SPRINGS ADULT DAY PROGRAMFACILITY NUMBER:
336423741
ADMINISTRATOR:KENNISHA CAREYFACILITY TYPE:
775
ADDRESS:997 E. TAHQUITZ CANYON WAYTELEPHONE:
(310) 944-3303
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY: 45CENSUS: 25DATE:
01/11/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Kennisha Carey, AdministratorTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Yolanda Delgado arrived to the Day Program unannounced to speak with Resident (R1) regarding issues and concerns advised. LPA Delgado was greeted by Administrator Kennisha Carey and was advised of the reason for the visit. Administrator Kennisha spoke to R1 and R1 agreed to speak with LPA Delgado at Day Program inside their conference room.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2023
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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