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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881135
Report Date: 03/22/2024
Date Signed: 03/22/2024 03:04:59 PM

Document Has Been Signed on 03/22/2024 03:04 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:RISING STAR CARE HOME LLCFACILITY NUMBER:
331881135
ADMINISTRATOR:REED, JAMES E.FACILITY TYPE:
740
ADDRESS:40600 CHANTEMAR WYTELEPHONE:
(951) 506-4002
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY: 6CENSUS: 5DATE:
03/22/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:James Reed - AdministratorTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of following up on open complaints for the previous facility license (#336425567). LPA Colvin reviewed prior resident files and interviewed Administrator James Reed.

No deficiencies observed related to the current license. An exit interview was conducted with Administrator James Reed and a copy of this report was provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2024
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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