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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881156
Report Date: 10/20/2023
Date Signed: 10/20/2023 01:07:33 PM

Document Has Been Signed on 10/20/2023 01:07 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:RICE FAMILY HOME, ARFFACILITY NUMBER:
361881156
ADMINISTRATOR:RICE, DAVIDFACILITY TYPE:
735
ADDRESS:20215 SAHALE RD.TELEPHONE:
(760) 927-8778
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY: 2CENSUS: 2DATE:
10/20/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Stephanie Rice TIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Mary Rico conducted an announced visit to the facility for the purpose of increasing the capacity. LPA was greeted and granted entrance by the Licensee Stephanie Rice.

Per the LIC200, Licensee requested for the capacity increase from two (2) ambulatory to four (4) ambulatory. The fire clearance request was approved on 06/28/2023 for four (4) ambulatory clients.

The licensee was advised that the noted designated capacity for each room is to remain in compliance.

LPA observed that the client bedrooms were appropriately furnished and had functional lighting. The physical plant is ready for an increase in capacity. LPA will update the facility's file and issue a new license stating change in capacity.

An exit interview was conducted where this report LIC809 was discussed and provided to the Licensee, Stephanie Rice.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2023
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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