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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800168
Report Date: 03/15/2024
Date Signed: 03/15/2024 08:31:24 AM

Document Has Been Signed on 03/15/2024 08:31 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:DULCE VILLA IIFACILITY NUMBER:
331800168
ADMINISTRATOR:MODY, NIKULFACILITY TYPE:
740
ADDRESS:66171 S AGUA DULCE DRTELEPHONE:
(760) 251-4606
CITY:DESERT HOT SPRINGSSTATE: CAZIP CODE:
92240
CAPACITY: 6CENSUS: 4DATE:
03/15/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Trupti Mody - AdministratorTIME COMPLETED:
08:30 AM
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Licensing Program Analyst (LPA) Crystal Colvin and Licensing Program Manager (LPM) Tricia Danielson hosted a virtual meeting via Zoom with Licensee/Administrators Nikul Mody and Trupti Mody.

This meeting was held to discuss outstanding corrections that needed to be made for deficiencies cited on 3/6/24. During this meeting, all outstanding deficiencies were cleared and letters confirming such will be provided via email and postal mail.

LPA Colvin reminded Licensees/Administrators Nikul and Trupti Mody that she still needed them to submit the LIC9098 Proof of Corrections form for all corrections, in order for them to testify that information provided is correct.

An exit interview was conducted with Licensees/Administrators Nikul and Trupti Mody and a copy of this report was provided via email and signature was requested.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2024
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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