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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880877
Report Date: 02/04/2022
Date Signed: 02/04/2022 03:45:42 PM

Document Has Been Signed on 02/04/2022 03:45 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
RIVERSIDE, CA 92507
FACILITY NAME:BIG HEARTS LOMAS VERDES, INC.FACILITY NUMBER:
361880877
ADMINISTRATOR:SCHAEFER, EVELINAFACILITY TYPE:
735
ADDRESS:25586 LOMAS VERDES STTELEPHONE:
(909) 328-2009
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY: 4CENSUS: 3DATE:
02/04/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Ronald ManaladTIME COMPLETED:
02:30 PM
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) Javier Prieto made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control. LPA met with Ronald Manalad and explained the purpose of the visit. There are currently no cases of COVID-19 within the facility.

Upon entry, facility staff followed protocol and had LPA sign in, use sanitation gel, and show proof of vaccination. LPA toured facility with direct staff and observed areas of the facility to clean and free of clutter. LPA asked questions related to staff and resident vaccination and it appears to this LPA that procedures are being followed per COVID prevention protocols.

LPA Prieto was experiencing computer malfunctions that prohibited the conclusion of an annual inspection. The computer malfunction detoured ability for facility staff and LPA to sign Facility Evaluation Report (LIC 809) at time of visit. Mr Manalad was notified that a continuation annual inspection will be conducted at a later date (02/08/2022).
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2022
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 1