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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336409083
Report Date: 08/29/2024
Date Signed: 08/29/2024 09:57:04 AM

Document Has Been Signed on 08/29/2024 09:57 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:VANDELON HOMECARE, INC.FACILITY NUMBER:
336409083
ADMINISTRATOR/
DIRECTOR:		MARLON UYFACILITY TYPE:
740
ADDRESS:1335 E. WHITTIER AVETELEPHONE:
(951) 791-0061
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY: 6CENSUS: 5DATE:
08/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Bernardo LazoTIME VISIT/
INSPECTION COMPLETED:
10:05 AM
NARRATIVE
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Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to deliver an amended copy of a previously issued report. LPA was granted entry and met with caregiver Bernardo Lazo who was informed of the purpose for the visit.


LPA conducted an exit interview and reviewed and provided copies of the amended report and this report to Williams.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
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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