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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336424625
Report Date: 02/16/2022
Date Signed: 02/16/2022 04:16:22 PM

Document Has Been Signed on 02/16/2022 04:16 PM - 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:CHICAGO HOUSE, THEFACILITY NUMBER:
336424625
ADMINISTRATOR:STANGEL, DEBORAHFACILITY TYPE:
735
ADDRESS:15055 CHICAGO AVENUETELEPHONE:
(951) 780-0850
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY: 6CENSUS: 6DATE:
02/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Lauren Garrett, AdministratorTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to initiate the investigation complaint #18-AS-20220215124817. The LPA met with Administrator, Lauren Garrett, and informed her of the purpose of the visit.

No health and safety concerns were observed at this time.

This report was reviewed with Garrett and a copy was provided.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2022
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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