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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800189
Report Date: 03/08/2023
Date Signed: 03/08/2023 01:17:35 PM

Document Has Been Signed on 03/08/2023 01:17 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:VALLEY STAR CRISIS RES. TREATMENT-HIGH DESERTFACILITY NUMBER:
361800189
ADMINISTRATOR:SYLVIA RODRIGUEZFACILITY TYPE:
772
ADDRESS:16552 SUNHILL DRIVETELEPHONE:
(760) 780-4400
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY: 16CENSUS: 15DATE:
03/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Silvia Rodriguez-AdministratorTIME COMPLETED:
01:25 PM
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Licensing Program Analysts (LPA's) Michelle Echeverria and Amber Coleman conducted an unannounced case management visit to this facility in regards to an incident report received by the Regional Community Care Office on 03/01/23 at 8:29 AM. After being granted access by the security guard, LPA's introduced themselves and stated the purpose of the visit to the Administrator, Silvia Rodriguez.

During today's visit, LPA's interviewed the Administrator to discuss the incident and surrounding events. LPA's were permitted to review staff statements regarding the incident as well as provided information regarding the care provided to the residents.

No deficiencies were observed during this visit. An exit interview was conducted where this report was discussed and then provided to Administrator, Silvia Rodriguez.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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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