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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425810
Report Date: 12/06/2024
Date Signed: 12/06/2024 09:39:38 AM

Document Has Been Signed on 12/06/2024 09:39 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:DANIEL HOMEFACILITY NUMBER:
336425810
ADMINISTRATOR/
DIRECTOR:		ADILENE QUINTANILLAFACILITY TYPE:
735
ADDRESS:30839 VIA PAREDTELEPHONE:
(760) 565-7905
CITY:THOUSAND PALMSSTATE: CAZIP CODE:
92276
CAPACITY: 6CENSUS: 4DATE:
12/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Abigail FlathTIME VISIT/
INSPECTION COMPLETED:
09:50 AM
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Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit to obtain a signature on an amended report. During today’s visit, LPA was greeted by Abigail Flath, who was informed of the purpose of the visit. A tour was conducted of the facility. No immediate health and safety concerns were observed during the visit

During today’s visit, LPA obtained Abigail Flath's signature on an amended version of a report originally delivered on 12-03- 2024.

An exit interview was conducted with Abigail Flath, and a copy of this report was provided.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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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