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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800189
Report Date: 12/05/2023
Date Signed: 12/05/2023 03:35:24 PM

Document Has Been Signed on 12/05/2023 03:35 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: 16DATE:
12/05/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Jesus Salazar- Program CoordinatorTIME COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Michelle Echeverrria conducted an unannounced case management visit to follow up on an incident report sent to licensing dated on 10/27/23. LPA introduced self and stated the purpose of the visit to Program Coordinator, Jesus Salazar.

During today's visit, LPA reviewed client records and interviewed the Program Coordinator to discuss the incident and surrounding events. Interview revealed that the individual involved in the incident is not an employee of the facility.

No deficiencies were observed during this visit. An exit interview was conducted where this report was discussed and then provided to Program Coordinator, Jesus Salazar.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
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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