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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426277
Report Date: 02/15/2022
Date Signed: 02/15/2022 10:19:03 AM


Document Has Been Signed on 02/15/2022 10:19 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:BLISSFUL CANYON HOMECAREFACILITY NUMBER:
336426277
ADMINISTRATOR:ROSALINDA ORLEANSFACILITY TYPE:
740
ADDRESS:1770 CENTURY AVE.TELEPHONE:
(951) 789-0170
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:6CENSUS: 0DATE:
02/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Rosalinda Orleans, LicenseeTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA), Stephanie Torres, made an unannounced visit to the facility to conduct the annual inspection. The LPA met with Licensee, Rosalinda Orleans, and informed her of the purpose of the visit.

There are no residents currently in care. The facility is currently undergoing renovations, which the Department was previously made aware of. There are currently no mitigation measures in place. The LPA informed Orleans mitigation measures should be put in place once residents are admitted into the facility. Orleans verbalized her understanding.

This report was reviewed with Orleans and a copy provided.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 295-3927
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2022
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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