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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880517
Report Date: 11/13/2023
Date Signed: 11/13/2023 03:27:24 PM

Document Has Been Signed on 11/13/2023 03:27 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ROSE VALLEY REDLANDS IIFACILITY NUMBER:
361880517
ADMINISTRATOR:MARCOS, MARSIE GAYFACILITY TYPE:
740
ADDRESS:1309 FARVIEW LNTELEPHONE:
(909) 283-4894
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY: 9CENSUS: 9DATE:
11/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Marsie Marcos, AdministratorTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced case management visit to the facility. LPA met with Marsie Marcos, Administrator and discussed the purpose of the visit.

LPA visited the facility to amend report LIC809-D that was previously issued on 11/13/2023.

An exit interview was conducted where this report was discussed and a copy of the report was provide to the Administrator
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2023
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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