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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423741
Report Date: 01/04/2024
Date Signed: 01/04/2024 10:25:44 AM

Document Has Been Signed on 01/04/2024 10:25 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: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: 33DATE:
01/04/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Norshay Easter, Program AdministratorTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct interviews for an open complaint for the facility( #18-AS-20230707083611). LPA was greeted and granted entry by Program Administrator Norshay Easter and explained the purpose of the visit.

LPA conducted the necessary interviews with the assistance of the Case Manager Sandy Herrera, due to a language barrier.

No health and safety concerns were observed.

An exit interview was conducted and a copy of this report was provided to Norshay Easter, Program Administrator.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2024
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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