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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880895
Report Date: 05/27/2021
Date Signed: 06/07/2021 08:38:03 AM

Document Has Been Signed on 06/07/2021 08:38 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ATTENTIVE MANOR IIFACILITY NUMBER:
331880895
ADMINISTRATOR:PECK, CHRISTOPHERFACILITY TYPE:
740
ADDRESS:31221 EL TORO RDTELEPHONE:
(760) 620-5915
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY: 6CENSUS: 6DATE:
05/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Christopher Peck, AdministratorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to conduct a required annual inspection, specific to infection control measures. The LPA met with Administrator, Christopher Peck, and informed him of the purpose of the visit.

The LPA toured the facility and observed for current infection control measures in place. The LPA observed a screening area, cleaning supplies, sufficient Personal Protective Equipment (PPE), recommended signage, etc. The facility has a Plan for Epidemic Outbreak specific to COVID-19 Mitigation Plan Report on file and in compliance with Community Care Licensing's recommendations. There are no health concerns at the time of this inspection.

This report was reviewed with Peck and a copy provided.

NOTE: Due to computer error, a manual copy was generated on this date. Signatures are on file.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE: DATE: 05/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/27/2021
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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