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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881330
Report Date: 12/06/2024
Date Signed: 12/06/2024 11:36:45 AM

Document Has Been Signed on 12/06/2024 11:36 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:DIAMOND COTTAGEFACILITY NUMBER:
331881330
ADMINISTRATOR/
DIRECTOR:		BRAVO, ARNOLDFACILITY TYPE:
740
ADDRESS:30778 DROPSEED DRIVETELEPHONE:
(951) 926-2398
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 6CENSUS: 5DATE:
12/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:Mike VitoTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit to obtain a signature on an amended report. During today’s visit, LPA was greeted by Caregiver Mike Vito, who was informed of the purpose of the visit. A tour was conducted of the facility. No immediate health and safety concerns were observed during the visit

During today’s visit, LPA obtained Mike Vito's signature on an amended version of a report originally delivered on 12-02- 2024.

An exit interview was conducted with Mike Vito, and a copy of this report was provided.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE: DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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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