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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800490
Report Date: 10/27/2023
Date Signed: 10/27/2023 07:56:47 PM

Document Has Been Signed on 10/27/2023 07:56 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:VILLA DESCANSO SENIOR LIVINGFACILITY NUMBER:
331800490
ADMINISTRATOR:TORRES, GABRIELAFACILITY TYPE:
740
ADDRESS:6683 LEANNE STREETTELEPHONE:
(909) 332-0311
CITY:EASTVALESTATE: CAZIP CODE:
91752
CAPACITY: 6CENSUS: 6DATE:
10/27/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
04:22 PM
MET WITH:Sharee GlissonTIME COMPLETED:
08:15 PM
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) Mary Rico conducted an unannounced case management visit to follow up on complaint control number 18-AS-20220207165851. LPA met with Sharee Glisson and explained the reason for the visit.

During today's visit, LPA interviewed R5 and delivered findings for complaint control number 18-AS-20220207165851

An exit interview was conducted, and this report was discussed and provided to staff Sharee Glisson.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2023
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