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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426759
Report Date: 09/03/2020
Date Signed: 09/03/2020 03:37:04 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:CITRUS GARDENSFACILITY NUMBER:
336426759
ADMINISTRATOR:KELLEY LARAFACILITY TYPE:
740
ADDRESS:25911 STANFORD STTELEPHONE:
(951) 925-7107
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:55CENSUS: 35DATE:
09/03/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Susie SlaveyTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Natalie Gayoso contacted the facility to conduct a Health & Safety Check via video conference (FaceTime) due to the COVID-19 pandemic. LPA identified herself and discussed the purpose of the tele-visit with Business Manager, Susie Slavey.

LPA toured the facility via FaceTime. LPA did not observe any immediate health or safety concerns. The facility had a sufficient amount of perishable and non-perishable food supplies. The Ms. Slavey stated that the facility was not experiencing any health or safety concerns. Ms. Slavey also stated that the facility has adequate staffing levels and enough supplies for the care of residents.

No deficiencies cited. An exit interview was conducted and this report was provided to Ms. Slavey via email.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie GayosoTELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2020
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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