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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425651
Report Date: 05/17/2023
Date Signed: 05/17/2023 04:15:51 PM


Document Has Been Signed on 05/17/2023 04:15 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:EAGEL TIME CARE FACILITYFACILITY NUMBER:
336425651
ADMINISTRATOR:JUAN CORNELLFACILITY TYPE:
740
ADDRESS:1622 PALERMO DRIVETELEPHONE:
(562) 685-4610
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY:6CENSUS: 6DATE:
05/17/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
03:56 PM
MET WITH:Administrator, Juan CornellTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted announced visit to the facility in order to conduct a case management, due to increase in capacity. LPA met with administrator, Juan Cornell who was informed of the purpose of the visit.

The licensee is seeking to increase their capacity from (6) ambulatory to (8) ambulatory. LPA reviewed the STD 850 conducted on 5/4/2023 by Riverside City Fire Department. The fire clearance was granted for (8) ambulatory. LPA reviewed the updated floor plan and conducted a tour of the facility. LPA observed the master bedroom, that was added with (2) resident beds and all required furniture. LPA observed working smoke alarms in all resident rooms.

No health and safety issues were observed during the time of the visit.

An exit interview was conducted where this report was reviewed and provided to, Administrator Juan Cornell.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023
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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