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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426759
Report Date: 08/28/2023
Date Signed: 08/28/2023 02:45:48 PM


Document Has Been Signed on 08/28/2023 02:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA



FACILITY NAME:CITRUS GARDENSFACILITY NUMBER:
336426759
ADMINISTRATOR:TRACY LANGENDOENFACILITY TYPE:
740
ADDRESS:25911 STANFORD STTELEPHONE:
(951) 925-7107
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:55CENSUS: 55DATE:
08/28/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Diana Molina Ramirez-Executive DirectorTIME COMPLETED:
02:51 PM
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 Licensing Program Analyst (LPA) Rayshaun Nickolas made an unannounced visit to the facility to investigate complaint control numbers 18-AS-20220503163805, 18-AS-20200820153416, and 18-AS-20200820154620. LPA Nickolas met with Wellness Coordinator Monica Quinones and explained the purpose of the visit. The Executive Director, Diana Molina Ramirez, later arrived at the facility. During today’s visit, LPA Nickolas toured the facility, interviewed clients and staff, reviewed and collected copies of documents.

LPA advised Molina Ramirez that, at this time, the complaints requires further investigation. Possible follow-up telephone calls, requests for copies of relevant documents, and visits are necessary before reaching investigative findings.

No deficiencies were cited during this visit. An exit interview was conducted with Molina Ramirez, and a copy of this report was provided.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:
DATE: 08/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/28/2023
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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