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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423741
Report Date: 10/10/2023
Date Signed: 10/10/2023 11:38:30 AM

Document Has Been Signed on 10/10/2023 11:38 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 AC/SC, 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:
(760) 322-6023
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY: 45CENSUS: 38DATE:
10/10/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Administrator, Norshay EasterTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to the facility to interview two (2) residents that attend the day program. This is a collateral visit due to SVS Palm Springs being licensed by Community Care Licensing, a Collateral report and an 811 are being left with the Administrator, Norshay Easter as evidence by her signature.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2023
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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