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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360904812
Report Date: 02/13/2023
Date Signed: 02/13/2023 12:11:49 PM


Document Has Been Signed on 02/13/2023 12:11 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:PLYMOUTH VILLAGE OF REDLANDSFACILITY NUMBER:
360904812
ADMINISTRATOR:MICHAELS, JULIEFACILITY TYPE:
741
ADDRESS:900 SALEM DRIVETELEPHONE:
(909) 793-1233
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:303CENSUS: 236DATE:
02/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Carol Steele-Director of human resources TIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPA) Bernadette Allen arrived at the facility unannounced to conduct a case management confirmation of removal order. LPA met with Carol Steele-Director of human resources and she was informed of the purpose of the visit. .

LPA interviewed Carol Steel and she said that Staff 1 (S1) has been disassociated from the facility on 1/31/2023.

Based on evidence obtained during today's visit, The LPA has verified the individual is not present, employed or residing at the facility. LPA has advised Carol Steele to disassociate the individual from their roster and submit an updated LIC500.

An exit interview was conducted and this report was discussed and a copy was provided to Carol Steele at the conclusion of the visit.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:
DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2023
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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