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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604260
Report Date: 10/16/2023
Date Signed: 10/16/2023 01:20:25 PM

Document Has Been Signed on 10/16/2023 01:20 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:WEAVER'S TWIN OAKS VILLAFACILITY NUMBER:
374604260
ADMINISTRATOR:WEAVER, TONYAFACILITY TYPE:
740
ADDRESS:2115 TWIN OAKS VALLEY ROADTELEPHONE:
(760) 798-4141
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 6CENSUS: 6DATE:
10/16/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Caregiver, Romelita GalaponTIME COMPLETED:
01:45 PM
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On 10/16/2023, Licensing Program Analyst (LPA) Janette Romero made an unannounced collateral visit to the facility for the purpose of obtaining information for complaint control #18-AS-20231011151002. The complaint is not against this facility.

LPA contacted Administrator, Babbit Gardner over the phone and requested copies of documentation pertinent to the investigation. LPA also attempted to interview Resident 1 (R1) at the facility.

An exit interview was conducted where a copy of this report was reviewed and provided to Caregiver, Romelita Galapon.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2023
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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