<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880686
Report Date: 12/02/2024
Date Signed: 12/02/2024 11:31:20 AM

Document Has Been Signed on 12/02/2024 11:31 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HELPING HEARTS BLACKWOODFACILITY NUMBER:
361880686
ADMINISTRATOR/
DIRECTOR:		CESAR ARGUETAFACILITY TYPE:
772
ADDRESS:11253 BLACKWOOD STTELEPHONE:
(909) 677-6644
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY: 6CENSUS: 5DATE:
12/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Brian Whitworth, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Becky Mann conducted an unannounced required 1-year visit to the facility. LPA met with Brian Whitworth and discussed the purpose of the visit. The facility is a Social Rehabilitation Facility, license capacity of 6 with a current census of 5 clients. LPA conducted an overall inspection of the facility, which included, but was not limited to the following:

LPA inspected the facility inside and out. Indoor and outdoor passageways are kept free of obstruction. Facility has no bodies of water. Facility backyard is fenced with self-latching gates. Facility has sufficient space for client indoor and outdoor activities. The facility has sufficient lighting and is maintained at a comfortable temperature.

LPA inspected the kitchen. Facility has sufficient non-perishable and perishable food for number of clients in care. Facility food is stored in a safe and healthful manner. Facility has sufficient cups, plates, and utensils for client use. Sharps, disinfectants, and chemicals are kept locked and inaccessible to clients in care.

LPA inspected client bedrooms. Bedrooms are equipped with beds, mattresses, bed linens, night stands, chairs, storage space, and sufficient lighting.

LPA inspected client bathrooms. Bathroom equipment is operating in safe and sanitary conditions. Hot water temperatures tested between 113 and 119 degrees Fahrenheit.

The facility is equipped with operating carbon monoxide and smoke alarms. Facility has posted in a common area the facility sketch, personal rights, disaster plan, Licensing complaint contact. Facility has sufficient supply of linen, towels, and hygiene products for clients in care.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HELPING HEARTS BLACKWOOD
FACILITY NUMBER: 361880686
VISIT DATE: 12/02/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA inspected client medications. Medications are labeled and administered as prescribed. Medications are kept locked and inaccessible to clients in care.

LPA reviewed client files for admission agreements, physician reports and record of client safeguarded resources. Client files are maintained and up to date.

LPA reviewed staff files for criminal record clearances, first aid certifications, training, and health screenings. Facility's staff records are up to date.

No deficiencies were cited during today's visit.

An exit interview was conducted, where the licensing reports LIC809 and LIC809C were discussed, and copies were provided to the Administrator at the conclusion of the visit.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2