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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360904812
Report Date: 05/25/2021
Date Signed: 05/25/2021 09:56:33 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:PLYMOUTH VILLAGE OF REDLANDSFACILITY NUMBER:
360904812
ADMINISTRATOR:MICHAELS, JULIEFACILITY TYPE:
741
ADDRESS:900 SALEM DRIVETELEPHONE:
(909) 793-1233
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:301CENSUS: 234DATE:
05/25/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Julie MichaelsTIME COMPLETED:
09:54 AM
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Licensing Program Analyst (LPA) Elecia Weathersby conducted a case management visit in order to increase the capacity per licensee request. LPA Weathersby met with Executive Director Julie Michaels and explained the purpose of the visit.

Licensee requested for a capacity increase from 301 clients to 303 clients. A Fire Clearance was approved on 3/20/21 for 303 non-ambulatory clients, for a total of 303 clients. Facility sketch on file shows sufficient square feet in the facility and activity rooms to accommodate the requested capacity. The room addition meets Title 22 Regulations for the ratio of bathrooms to clients for the capacity requested.

The physical plant is ready for increase in capacity. LPA Weathersby will has notified the Executive Director of final capacity increase approval. LPA Weathersby further advised the Executive Director that the new license will follow in the mail after capacity increase visit.

An exit interview was conducted where this report was discussed and a copy was provided to Executive Director Julie Michaels.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Elecia WeathersbyTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 05/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/25/2021
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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