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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880547
Report Date: 05/27/2022
Date Signed: 05/27/2022 12:07:33 PM


Document Has Been Signed on 05/27/2022 12:07 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:DESERT HORIZON RESIDENTIAL CAREFACILITY NUMBER:
361880547
ADMINISTRATOR:SHATTLES=BREEDLOVE, ANGELAFACILITY TYPE:
740
ADDRESS:15952 CONDOR RDTELEPHONE:
(760) 552-4352
CITY:VICTORVILLESTATE: CAZIP CODE:
92394
CAPACITY:6CENSUS: 6DATE:
05/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Kellsie MozingoTIME COMPLETED:
12:09 PM
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Licensing Program Analyst (LPA) Anna Bueno conducted a case management visit. LPA identified herself to care staff, Kellsie Mozingo. Staff Henrietta Chavez arrived shortly and staff Mozingo left before the conclusion of the visit. Licensee Angela Shattles-Breedlove arrived and was advised of the purpose of today's visit.

During today's visit, LPA and staff toured the facility inside and outside. LPA observed all areas of the facility, including resident bedrooms and restrooms, appeared clean and in good repair. LPA observed all utilities and appliances were functioning properly. LPA observed sufficient food/water supply and emergency supplies. LPA observed that medications and dangerous objects were kept inaccessible to residents in care.

Technical violations were issued as LPA observed that the emergency exit of bedroom 5 was obstructed by a back rest pillow and a medical supplies bin, and facility staff were not wearing face coverings. LPA observed the right metal gate was locked with a bolt. Technical violations were corrected during the visit.

An exit interview was conducted where this report, LIC-9102A, and appeal rights were discussed and a copy of this report was provided to Licensee at the conclusion of the inspection.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:
DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/20/2022
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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