<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423672
Report Date: 10/16/2024
Date Signed: 10/16/2024 12:24:49 PM

Document Has Been Signed on 10/16/2024 12:24 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:DESERT COTTAGE IIFACILITY NUMBER:
336423672
ADMINISTRATOR/
DIRECTOR:		ELIZABETH HENGSTLERFACILITY TYPE:
740
ADDRESS:83-421 MATADOR COURTTELEPHONE:
(760) 342-7767
CITY:INDIOSTATE: CAZIP CODE:
92203
CAPACITY: 6CENSUS: 1DATE:
10/16/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Elizabeth Hengstler, licenseeTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA) Seo Jeon and Ferrer Sabarias conducted an announced visit to the facility to conduct an interview with Resident One (R1) regarding an open complaint unrelated to this facility.

LPA met with Elizabeth Hengstler, licensee, who was informed of the purpose for the visit.

During today's visit, LPA did not observe any issues or concerns. An exit interview was a conducted and a copy of this report was reviewed and provided to Elizabeth Hengstler.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1