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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412261
Report Date: 09/21/2022
Date Signed: 09/21/2022 01:26:17 PM

Document Has Been Signed on 09/21/2022 01:26 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MICHAEL ANDREW CENTERFACILITY NUMBER:
336412261
ADMINISTRATOR:ROMEO LABASTIDAFACILITY TYPE:
740
ADDRESS:10904 ARIZONA AVETELEPHONE:
(951) 343-9197
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY: 6CENSUS: 6DATE:
09/21/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Romeo Labastida, AdminstratorTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA), Yolanda Delgado, arrived unannounced to the facility to conduct a case management visit to check on the health, safety, and welfare of residents in care. LPA met with Administrator, Romeo Labastida, and explained the purpose of the visit.
Four (4) residents in care were present during visit; one (1) at Bible Study and one (1) at Program. No imminent health and/or safety concerns were observed at the time of visit. The LPA observed no health and/or safety hazards inside the facility. The LPA observed all facility utilities to be on and operating without issue. There was a sufficient amount of staff present at the facility to provide care. The LPA assessed the available food supply and observed the home to meet the required two (2) day supply of perishable foods and a seven (7) day supply of non-perishable foods. Medications were found to be in sufficient supply as well.

Based on the information obtained during today’s visit, there are no immediate threats to the health, safety, and welfare of the residents in care. No deficiencies were cited during today’s visit.

An exit interview was conducted with Romeo Labastida and a copy of this report was provided.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2022
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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