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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881065
Report Date: 03/03/2023
Date Signed: 03/20/2023 09:59:18 AM


Document Has Been Signed on 03/20/2023 09:59 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:YORKSHIRE GARDEN CARE #1FACILITY NUMBER:
361881065
ADMINISTRATOR:LALA, ADETUTU E.FACILITY TYPE:
740
ADDRESS:12667 YORKSHIRE DRIVETELEPHONE:
(760) 605-4674
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY:6CENSUS: DATE:
03/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:N/ATIME COMPLETED:
10:20 AM
NARRATIVE
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Licensing Program Analyst Victoria Chitgian arrived to the facility on an unannounced visit to conduct a required annual inspection.
LPA knocked on the door, and an individual opened the door. LPA introduced herself and the purpose of the visit. Individual stated her name is Ester, and said this home is an AirBnB. She stated she and her family have been placed to stay here by her insurance company for two (2) days.
LPA asked Ester if there are any elderly living in the home, to which Ester stated "No, it is just me and my family and kids"
LPA asked Ester if there are any wheelchairs or supplies for the elderly around the home, to which Ester stated "No, its just an Airbnb.
LPA left a business card with the individual. LPA walked to the gate to observe the backyard and noticed a childrens playground with swingset, basketball court and balls.

LPA placed a phone call to Licensee ph#.
Call was not answered. LPA left a voicemail with instructions to call the Regional office with changes regarding the status of the facility. Callback number was provided.
Visit attempt ended.



LPA Chitgian verbally provided the above information to LPA Rayshaun Nickolas regarding the closure.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Victoria ChitgianTELEPHONE: (951) 248-0306
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2023
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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