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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880948
Report Date: 02/22/2023
Date Signed: 02/22/2023 03:36:01 PM

Document Has Been Signed on 02/22/2023 03:36 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:VNL ARF II LLCFACILITY NUMBER:
361880948
ADMINISTRATOR:ANN CLARKFACILITY TYPE:
735
ADDRESS:1205 W. BOHNERT AVETELEPHONE:
(909) 990-0299
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY: 3CENSUS: DATE:
02/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Anna Clarke, AdministratorTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analysts, Amber Coleman and Amy Goldenberg (LPA Coleman, LPA Goldenberg) arrived at the VNL ARF facility to return pertinent documents collected during the prior visit 2/22/23 at 1:20PM. LPA's collected documents pertaining to the resident for the purposes of making copies. LPA's introduced self and stated purpose of the visit. LPA Coleman provided the documents collected to Administrator, Ann Clarke. With the assistance of her staff, Administrator counted the number of documents returned and verified the amount of pages. Administrator confirmed that there were 192 pages consistent with the amount of documents collected.

No deficiencies were observed during the visit. LPA conducted an exit interview where this report was provided to Administrator.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2023
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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