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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800429
Report Date: 07/06/2023
Date Signed: 07/06/2023 10:55:39 AM

Document Has Been Signed on 07/06/2023 10:55 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HELPING HEARTS BONANZAFACILITY NUMBER:
361800429
ADMINISTRATOR:MANUEL SOTOFACILITY TYPE:
772
ADDRESS:14516 BONANZA ROADTELEPHONE:
(909) 771-9940
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 10CENSUS: 10DATE:
07/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:Frank Pesqueira-Program DirectorTIME COMPLETED:
10:58 AM
NARRATIVE
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Licensing Program Analyst (LPA) Michelle Echeverria arrived at the facility unannounced to conduct a Case Management Visit for health and safety. This case management visit is in response to a Special Incident Report (SIR) submitted to the Community Care Licensing Office on 5/30/23. LPA was greeted by Staff, Franchette Maddox at the front door. LPA introduced self and stated purpose of the visit. Staff notified the Program Director of LPA's arrival, while LPA was asked to sign in. LPA met with Frank Pesqueira, Program Director who was informed of the reason for today's visit.

On 05/23/23 Client (C1) reported to staff and Program Director that they had experienced multiple instances of sexual assault in their past.

During today's visit, LPA met with Pesqueira in the activity room to discuss the incident and surrounding events. LPA did a health and safety check, reviewed (C1) Physician's report, ISSP and interviewed (C1).

No deficiencies were observed during this visit. An exit interview was conducted where this report was, reviewed, discussed and then provided to Program Director, Frank Pesqueira.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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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