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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880686
Report Date: 07/28/2023
Date Signed: 07/28/2023 03:39:41 PM

Document Has Been Signed on 07/28/2023 03:39 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:HELPING HEARTS BLACKWOODFACILITY NUMBER:
361880686
ADMINISTRATOR:CESAR ARGUETAFACILITY TYPE:
772
ADDRESS:11253 BLACKWOOD STTELEPHONE:
(909) 677-6644
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY: 6CENSUS: 6DATE:
07/28/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Arthur Estrada - Program DirectorTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to conduct a case management visit in relation to an incident report received by the Department on 07/24/2023. LPA met with program director Arthur Estrada (PD) who was informed of the reason for today's visit.

The report stated that on 07/11/23 PD received information that Staff 1 (S1) made inappropriate sexual remarks towards clients on 07/10/23.

Interviews with staff and clients revealed that S1 is not a scheduled employee at this home and was present at this facility only on the day of the incident. Interviews with clients revealed that S1 was observed by Client 2 (C2) making inappropriate statements to Client 1 (1) and C2 reported the incident to staff working the next shift. Interviews further revealed that staff reported the inappropriate interaction to PD who then notified proper authorities and agencies. Client and staff interviews confirmed that S1 has not returned to this facility since the reported incident.

No deficiencies were cited during today's visit. A copy of this report was reviewed and provided to Mr. Estrada
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2023
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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