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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881214
Report Date: 03/03/2023
Date Signed: 03/03/2023 12:50:48 PM

Document Has Been Signed on 03/03/2023 12:50 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BELLES COURTFACILITY NUMBER:
331881214
ADMINISTRATOR:ANCHONDO, JESSICAFACILITY TYPE:
735
ADDRESS:6770 CONDOR DRTELEPHONE:
(323) 945-5605
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
92509
CAPACITY: 4CENSUS: 1DATE:
03/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Facility Administrator, Christian C.TIME COMPLETED:
12:50 PM
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Licensing Program Analyst, Amber Coleman (LPA) arrived at the Belle's Court Facility for a Case Management visit for the purposes of making a correction to the report provided during an earlier visit. LPA and Administrator reviewed changes. LPA provided corrected report to Administrator and concluded the visit.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2023
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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