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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426206
Report Date: 04/23/2021
Date Signed: 04/23/2021 11:28:07 AM

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:DESERT CARE VILLAFACILITY NUMBER:
336426206
ADMINISTRATOR:MARY MEDINAFACILITY TYPE:
740
ADDRESS:69584 PLEASANT GROVETELEPHONE:
(760) 992-8136
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:6CENSUS: 0DATE:
04/23/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Mary Jane Medina, LicenseeTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Stephanie Torres conducted an announced case management visit at the facility to inspect the home prior to closure. The closure was Licensee initiated, notice was received by the Department on 04/21/21. The LPA met with Licensee, Mary Jane Medina and was allowed entrance into the home.

LPA conducted a walk through with Alvarado and found no residents in the home. The LPA explained to Medina the license is no longer valid and therefore no required care and supervision should be provided in the home unless the state approves licensure in the future.

This report was discussed with and provided to Medina.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021
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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