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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881177
Report Date: 04/26/2023
Date Signed: 04/26/2023 03:59:24 PM

Document Has Been Signed on 04/26/2023 03:59 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:AMETHYST BEHAVIORAL HEALTH, LLCFACILITY NUMBER:
361881177
ADMINISTRATOR:RICHARDSON, SANDRAFACILITY TYPE:
772
ADDRESS:921,923,925 TRIBUNE STREETTELEPHONE:
(909) 809-9293
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY: 12CENSUS: 12DATE:
04/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:44 PM
MET WITH:Sandra Richardson, AdministratorTIME COMPLETED:
04:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced case management visit to the facility. LPA met with Administrator, Sandra Richardson and discussed the purpose of the visit.

LPA amended a report regarding complaint control #56-AS-20230214172643 that was previously issued on 2/21/23.

No deficiencies were cited during the visit. An exit interview was conducted where this report was discussed and provided to the Administrator.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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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