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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881007
Report Date: 08/23/2023
Date Signed: 08/23/2023 10:43:42 AM

Document Has Been Signed on 08/23/2023 10:43 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:PURE HOPE CAREFACILITY NUMBER:
331881007
ADMINISTRATOR:FADDOUL, LEVIFACILITY TYPE:
740
ADDRESS:78740 SANITA DRIVETELEPHONE:
(661) 810-7293
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY: 6CENSUS: 5DATE:
08/23/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Caregiver Milagro PerezTIME COMPLETED:
11:00 AM
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On August 23, 2023 at 9:05am, Regional Manager (RM) Reyna Lacey, Licensing Program Analyst (LPA) Tricia Danielson and Licensing Program Analyst (LPA) Javina George made an unannounced case management other visit to conduct resident and staff interviews related to complaint control number 18-AS-20230320145558. RM Lacey and LPAs Danielson and George were greeted and granted entry by Caregiver Milagro Perez.

The purpose of the visit was explained to Milagro. The Administrator Levi Faddoul was unable to come to the facility at during RM and LPAs' visit. An additional tour was conducted of the interior and exterior of the facility.

An exit interview was conducted and a copy of this report was reviewed and provided Caregiver Milagro Perez.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2023
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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