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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425070
Report Date: 09/20/2022
Date Signed: 09/20/2022 03:03:44 PM


Document Has Been Signed on 09/20/2022 03:03 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:ELDORADO SENIOR HOMECARE, LLCFACILITY NUMBER:
336425070
ADMINISTRATOR:ANITA C. FLETCHERFACILITY TYPE:
740
ADDRESS:19465 ELDORADO ROADTELEPHONE:
(951) 776-0947
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY:6CENSUS: 0DATE:
09/20/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Anita Fletcher, Licensee
Antoinio Alampi, Administrator		TIME COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Chinwe Nwogene conducted an announced visit for the purpose of the facility's closure. LPA met with Licensee, Anita Fletcher and Administrator, Antoinio Alampi.

Licensee contacted LPA previously on 9/2/2022 about closing the facility due to lack of clients. The Licensee is initiating this closure. The effective date of closure is 9/20/2022.

During today's visit, LPA toured the facility, and observed no staff, no residents in care, and no resident's belongings. Anita stated that the facility had one #1 resident and the resident was picked up by her responsible party on the 9/15/2022. Licensee gave LPA name of the resident. Name, phone number and address of the resident's responsible party.

Anita submitted the License to LPA at the time of the closure. LPA explained to Anita that the license is no longer valid and therefore no required care and supervision should be provided in the home unless the state approves licensure in the future.

An exit interview was conducted where this report was discussed with and provided to Anita Fletcher.

SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2022
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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