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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800210
Report Date: 04/24/2023
Date Signed: 04/24/2023 10:02:11 AM


Document Has Been Signed on 04/24/2023 10:02 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
, CA 92507



FACILITY NAME:ARIES RESIDENTIAL CARE INCFACILITY NUMBER:
361800210
ADMINISTRATOR:ROGOVIN, ROBERTFACILITY TYPE:
740
ADDRESS:17892 SYCAMORE STTELEPHONE:
(760) 821-9172
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:6CENSUS: DATE:
04/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:43 AM
MET WITH:Rob Rogovin, Licensee/Administrator TIME COMPLETED:
10:07 AM
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On 04/24/2023 at 9:43 a.m., Licensing Program Analysts (LPAs) Rayshaun Nickolas made an unannounced visit to the facility to obtain signatures on amended LIC 9099D. LPA met with Licensee/Administrator Rob Rogovin and explained the purpose of the visit.

An exit interview was conducted and a copy of this report and amended LIC 9099d were provided to Rogovin
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:
DATE: 04/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/24/2023
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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