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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425920
Report Date: 09/25/2023
Date Signed: 10/10/2023 07:27:30 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 10/10/2023 07:27 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:CARMIE CARES HOME FOR THE ELDERLY 2FACILITY NUMBER:
336425920
ADMINISTRATOR:JAY CHRISTIAN SESEFACILITY TYPE:
740
ADDRESS:32475 RANCHO VISTA DRIVETELEPHONE:
(760) 770-6818
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:6CENSUS: 0DATE:
09/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA), Kathleen Banrasavong attempted to conduct an unannounced annual at the facility. LPA knocked on the door and rang the door bell; no answer. LPA contacted Licensee/ Administrator, Jay Sese, who stated he submitted a letter on June 1, 2023 for a request to close the facility due to Licensee selling the property. Licensee confirmed that all residents were removed from the home. Licensee stated he was unable to return the facility's license due to Licensee not being able to locate. LPA was unable to meet with the Licensee. LPA verbally provided this 809 through the phone and sent to Licensee in an email.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen BanrasavongTELEPHONE: 951-248-0319
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2023
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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