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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366427615
Report Date: 11/05/2021
Date Signed: 11/05/2021 12:35:11 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:
11/05/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:38 AM
MET WITH:Dulce Redford, AdministratorTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Anna Bueno made an unannounced visit to the facility for the purpose of obtaining information on the current status of the home. Community Care Licensing (Department) received information indicating the Licensee has failed to make rental payments, which has resulted in a pending eviction. The LPA was greeted by licensee, Dulce Redford, and staff Reymundo Yap, and informed of the purpose of the visit.

On this visit the LPA toured the facility, observed three (3) residents in care, sufficient food and supplies, and working utilities. No health and safety concerns were observed on this visit. No citations have been issued at this time. LPA informed licensee and staff 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 and Yap were advised to maintain good communication with the Department in order to remain updated on the status of the facility.

Licensee left the facility therefore the exit interview was conducted with staff Yap, where a copy of this report was provided.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021
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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