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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881052
Report Date: 06/21/2023
Date Signed: 06/21/2023 01:54:58 PM

Document Has Been Signed on 06/21/2023 01:54 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:VIEW CREST HOMEFACILITY NUMBER:
361881052
ADMINISTRATOR:CARR, ERICA SHARDEFACILITY TYPE:
735
ADDRESS:17641 VIEW CREST COURTTELEPHONE:
(818) 309-7821
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY: 4CENSUS: 4DATE:
06/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Erica Carr-AdministratorTIME COMPLETED:
02:00 PM
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On 6/21/23 at 12:30 PM, Licensing Program Analyst (LPA) Michelle Echeverria conducted an announced visit to the facility for the purpose of approving the facility's request for non-ambulatory status change. LPA was greeted and granted entrance by the Administrator, Erica Carr.

Per the LIC200, Erica submitted a change of status from 4 ambulatory to 3 ambulatory and 1 non-ambulatory on 02/01/2023. The fire clearance request was approved on 05/16/2023 for three (3) ambulatory and one (1) non-ambulatory. There is a facility sketch on file with designation of the non-ambulatory bedroom.

During today’s visit, LPA toured the facility and inspected bedrooms #1, #2, #3 and #4. LPA observed that bedrooms #1, #2, #3 and #4 were in good repair and had the required furniture. LPA observed bedroom # 1 with an exit door leading directly outside of the facility. The physical plant is ready for a non-ambulatory status change. LPA will update the facility's file and issue a new license stating change in non-ambulatory.

No deficiencies were cited during this visit. An exit interview was conducted where this report LIC809 was discussed and provided to the Administrator, Erica Carr.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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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