<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366401737
Report Date: 04/18/2022
Date Signed: 04/18/2022 10:20:48 AM


Document Has Been Signed on 04/18/2022 10:20 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:RAINBOW BOARD AND CAREFACILITY NUMBER:
366401737
ADMINISTRATOR:MANJARREZ, MARINOFACILITY TYPE:
740
ADDRESS:13557 THIRD STREETTELEPHONE:
(909) 795-8144
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:6CENSUS: 0DATE:
04/18/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Marino ManjarrezTIME COMPLETED:
10:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Melody Brown conducted an announced visit at the facility 04/18/2022 at 09:45 AM to confirm that all the residents have been relocated in anticipation for the facility's closure. LPA Brown was granted entrance by Administrator/Licensee Marino Manjarrez.

On 03/28/2022, LPA Brown was informed that there are no more residents living in the facility. The licensee is initiating this closure. LPA Brown inspected the entire facility which included the bedrooms, bathrooms, dining area, kitchen, and the backyard. There were no residents present, and there were no belongings of residents in the facility. Administrator/Licensee Manjarrez stated that the reason of the closure is due to Administrator/Licensee’s decision to retire.



The Administrator/Licensee submitted the following during the closure plan.

1. Letters to clients indicating the closure, and letter to Community Care Licensing (CCL).
2. Names of the two (2) residents (resident roster).

The Licensee/Administrator surrendered the original license to LPA Brown.

The effective date of closure will be 04/18/2022.

An exit interview was conducted where this report was discussed with and provided to Administrator/Licensee Marino Manjarrez.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1