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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880879
Report Date: 06/12/2024
Date Signed: 06/12/2024 03:21:48 PM

Document Has Been Signed on 06/12/2024 03:21 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BIG HEARTS COTTONWOOD, INC.FACILITY NUMBER:
361880879
ADMINISTRATOR/
DIRECTOR:		MANALAD, RONALDFACILITY TYPE:
735
ADDRESS:25556 COTTONWOOD RDTELEPHONE:
(909) 328-2446
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY: 4CENSUS: 4DATE:
06/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Heidy SembelTIME VISIT/
INSPECTION COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced follow-up facility visit to gather information pertaining to complaint # 56-AS-20230801155249 investigation. LPA met with Heidy Sembel, Direct Care Staff and discussed the purpose of the visit.

During today’s visit, LPA conducted interviews and obtained copies of relevant documents.

An exit interview was conducted where this report was discussed and a copy of this report was provided to the Heidy Sembel at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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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