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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366427615
Report Date: 07/23/2021
Date Signed: 07/23/2021 02:55:14 PM

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
RIVERSIDE, CA 92507
FACILITY NAME:GARDEN VILLE HOME CAREFACILITY NUMBER:
366427615
ADMINISTRATOR:ADA REYESFACILITY TYPE:
740
ADDRESS:6206 WALNUT AVETELEPHONE:
(909) 548-0487
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY:6CENSUS: 3DATE:
07/23/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Leo Cardenas, StaffTIME COMPLETED:
03:00 PM
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Licensee Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to obtain information on the current status of the home. The Department received information indicating the Licensee has failed to make rental payments, which has resulted in a pending eviction. The LPA was greeted by staff, Leo Cardenas, and informed him of the purpose of the visit. The LPA spoke with Licensee, Dulce Redford, via telephone and informed her of the purpose of the visit.

On this visit the LPA toured the facility, observed three (3) residents in care, sufficient food supplies, working utilities, and staff available. No health and safety concerns were observed on this visit. No citations have been issued at this time. The LPA informed Licensee Redford the health, safety and personal rights of the residents in care are jeopardized when rental payments are not made and a possible eviction is pending. Redford was advised to maintain good communication with the Department in order to remain updated on the status of the facility.

This report was reviewed with Redford via telephone and a hard copy was provided.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 07/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2021
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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