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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881421
Report Date: 02/06/2025
Date Signed: 02/06/2025 04:28:09 PM

Document Has Been Signed on 02/06/2025 04:28 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:SMITH ROAD ASSISTED LIVINGFACILITY NUMBER:
331881421
ADMINISTRATOR/
DIRECTOR:		LECITA, MA SATCHELFACILITY TYPE:
740
ADDRESS:753 SMITH ROADTELEPHONE:
(951) 927-8178
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY: 12CENSUS: DATE:
02/06/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Administrator Ma Satchel LecitaTIME VISIT/
INSPECTION COMPLETED:
04:35 PM
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On February 2, 2025, Licensing Program Analyst Armando Perez and Kathleen Banrasavong conducted a visit to the facility in order to obtain information regarding a request for an eviction. LPAs were granted entry and met with Administrator Ma Satchel Lecita.

LPAs conducted interviews with two residents and reviewed pertinent documentation. During the course of the investigation, LPAs observed that the facility had not reported serious incidents to the department. Per title 22, the facility must report all incidents to the department within a 7 day period. A technical violation will be provided.

An exit interview was conducted, and a copy of this report was provided to Administrator Ma Satchel Lecita.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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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