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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426470
Report Date: 12/08/2021
Date Signed: 12/08/2021 12:47:50 PM

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:ATTENTIVE MANORFACILITY NUMBER:
336426470
ADMINISTRATOR:MATTHEW SIEGELFACILITY TYPE:
740
ADDRESS:66-338 FOURTH ST.TELEPHONE:
(760) 251-4330
CITY:DESERT HOT SPRINGSSTATE: CAZIP CODE:
92240
CAPACITY:6CENSUS: 0DATE:
12/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Licensee, Matthew Siegel TIME COMPLETED:
01:00 PM
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On 12/8/21 LPA's Venus Mixon and David Cuevas conducted an unannounced visit to the the facility, upon arriving at the facility and meeting with Licensee, Matthew Siegel he informed LPA's of his possible plans of closing facility and selling the home. Per Licensee, there has been no residents in placement since December 2020.

During this visit LPA's tour the interior and exterior of home and identified no residents to be in care and no staff present at the time of visit. Per Licensee, no relocation of residents took place as residents in placement passed away due to COVID outbreak in December 2020.

LPA's requested from Licensee that upon determining the closure status he is to surrender the facility license to CCL, provide a closure statement, and provide summary of residents relocation.

An exit interview was done with Licensee were this report was reviewed and provided.

SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: David CuevasTELEPHONE: (951) 295-3927
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021
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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