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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
361880786
Report Date:
01/04/2023
Date Signed:
01/04/2023 02:25:09 PM
Document Has Been Signed on
01/04/2023 02:25 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:
SUMMERFIELD OF REDLANDS
FACILITY NUMBER:
361880786
ADMINISTRATOR:
HEDI CHARETTE
FACILITY TYPE:
740
ADDRESS:
1319 BROOKSIDE AVENUE
TELEPHONE:
(909) 793-9500
CITY:
REDLANDS
STATE:
CA
ZIP CODE:
92373
CAPACITY:
75
CENSUS:
44
DATE:
01/04/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
02:20 PM
MET WITH:
Hedi Charette Administrator
TIME COMPLETED:
02:35 PM
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The LIC9099 and LIC9099-C for complaint number
COMPLAINT CONTROL NUMBER
:
56-AS-20220921101913 was signed on 1/4/2023.
SUPERVISOR'S NAME:
Karen Clemons
TELEPHONE:
(951) 248-0349
LICENSING EVALUATOR NAME:
Bernadette Allen
TELEPHONE:
951-897-2618
LICENSING EVALUATOR SIGNATURE:
DATE:
01/04/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
01/04/2023
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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