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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530280
Report Date: 01/03/2025
Date Signed: 01/03/2025 02:18:11 PM

Document Has Been Signed on 01/03/2025 02:18 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:LIFETIME ADULT DAY CAREFACILITY NUMBER:
365530280
ADMINISTRATOR/
DIRECTOR:		WINSSER, JOHNNYFACILITY TYPE:
775
ADDRESS:9229 UTICA AVE #140TELEPHONE:
(909) 609-9049
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY: 30CENSUS: 0DATE:
01/03/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Johnny Winsser, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Javier Prieto conducted an announced follow up Prelicensing visit 01/03/2025. This is an announced second Pre-Licensing visit conducted with Executive Director Johnny Winsser who assisted in the tour of inside and outside of facility and the evaluation. LPA Prieto toured facility with Executive Director Winsser and found the facility to be in compliance.

The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22. Based on the observations and evaluation of the facility this date, the facility is ready for licensure. LPA completed COMP III with the Licensee at the conclusion of the inspection.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2025
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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