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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881134
Report Date: 04/07/2022
Date Signed: 04/07/2022 01:11:19 PM


Document Has Been Signed on 04/07/2022 01:11 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:ALLARA SENIOR LIVINGFACILITY NUMBER:
361881134
ADMINISTRATOR:HEFNER, LEEANNFACILITY TYPE:
740
ADDRESS:9417 19TH STREETTELEPHONE:
(909) 736-1900
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY:120CENSUS: 40DATE:
04/07/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:06 PM
MET WITH:Lee Ann Hefner, Executive DirectorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Rohit Lama conducted a Case Management Visit. During the visit, LPA conducted an inspection of facility premises and observed and spoke with residents in care.

LPA met with Lee Ann Hefner, Executive Director.

Food supply and resident medication were inspected. LPA spoke with a portion of the residents who all stated that they were doing well, felt safe and cared for, and had no concerns at this time.

At this time, no deficiencies were issued. No immediate health or safety concerns noted.

An exit interview was conducted, where this report was discussed with the Executive Director and a copy was also provided.

SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Rohit LamaTELEPHONE: 951-217-9826
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
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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