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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336423672
Report Date: 12/11/2024
Date Signed: 12/11/2024 12:31:48 PM

Document Has Been Signed on 12/11/2024 12:31 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: DATE:
12/11/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Terri DuetTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA),Abdoulaye Zerbo conducted an unannounced visit to the facility for a case management. The LPA met with Facility Administrator Destiny Villalta, and informed her of the purpose for the visit and were granted access.

The facility is a single story building and consists of three(3) resident rooms, one(1) staff room and three (3) bathrooms. The LPA obtained copies of relevant documentation such as the LIC 500 Personnel Report and client roster. LPAs observed current personnel to be fingerprint cleared and listed on the facility's personnel report. There is currently one (1) resident in care.

LPA's case management included interview with management and resident, obtaining relevant documentation and conducting a tour of the facility for a health and safety check. No health and safety concern were observed during today's visit.

Further review is needed at this time. Possible visits and phone interviews will be conducted before a decision is rendered. An exit interview was conducted, and a copy of this report was provided to Administrator Destiny Villalta.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
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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