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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530284
Report Date: 03/07/2025
Date Signed: 03/07/2025 10:58:38 AM

Document Has Been Signed on 03/07/2025 10:58 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
CENTRALIZED APP UNIT, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:ARYZE CARE HOME LLCFACILITY NUMBER:
365530284
ADMINISTRATOR/
DIRECTOR:		GARCIA, JUSTOFACILITY TYPE:
740
ADDRESS:14426 JOAQUIN WAYTELEPHONE:
(760) 684-2863
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY: 4CENSUS: 0DATE:
03/07/2025
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Justo Garcia, Administrator/Member
Maria Garcia, Member		TIME VISIT/
INSPECTION COMPLETED:
10:51 AM
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
Component II completion: Successful

Facility Type: Residential Care Facility for the Elderly (RCFE)
Application Type: Initial
Capacity: 4
Census (if any clients in care): none
COMP II Participants: Justo Garcia, Administrator/Member
Maria Garcia, Member
Interview Method: Virtual interview (Microsoft Teams)

On March 7, 2025 at 9:30 AM, Applicant and Administrator participated in COMP II. Identification of the Applicant and Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant and Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22.

During COMP II, CAB analyst confirmed Applicant and Administrator’s understanding of following areas:
1. Facility Operation: License Type, Client/Resident Populations, and Program.
2. Admission Policies
3. Staffing requirements & Training
4. Restrictive/Prohibited Health Conditions
5. General Provisions
6. Emergency Preparedness
7. Complaints & Reporting
8. Pre-licensing Readiness

Exit interview. Report sent via email to Applicant and Administrator. Informed to return sign copy to CAB by end of business day today.
SUPERVISORS NAME: Tracy Thompson
LICENSING EVALUATOR NAME: Celia Phomphachanh
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2025
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