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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425849
Report Date: 09/27/2023
Date Signed: 10/16/2023 08:30:43 AM


Document Has Been Signed on 10/16/2023 08:30 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:AFFORDABLE ASSISTED LIVINGFACILITY NUMBER:
336425849
ADMINISTRATOR:RUIZ, GEORGEFACILITY TYPE:
740
ADDRESS:28549 HEATHER GREEN WAYTELEPHONE:
9513014259
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY:6CENSUS: 0DATE:
09/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:53 PM
MET WITH:Michael ParkhouseTIME COMPLETED:
02:38 PM
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On 09/27/23, Licensing Program Analyst (LPA) Cheryl Goodrich conducted an unannounced visit for the purpose of the facility's closure. LPA met with Michael Parkhouse, the licensee’s brother-in-law.

Licensee contacted previous LPM Joel Esquivel on October 2022 about closing the facility due to no longer having help to run the facility. The Licensee is initiating this closure. The effective date of closure is.

During today's visit, LPA toured the facility, and observed no staff, no residents in care, and no resident's belongings. George stated facility had four 4 clients and all four clients has been relocated by the family members of the residents LPA was able to confirm that all 3 residents were relocated by their families in October 2022, the 4th resident was relocated to Sun City Gardens by the licensee.

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 LPA explained to Michael Parkhouse and George Ruiz that the license is no longer valid and therefore no required care and supervision should be provided in the home unless the state approves licensure in the future.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

SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Cheryl GoodrichTELEPHONE: 951-248-0308
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2023
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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