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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881216
Report Date: 06/17/2024
Date Signed: 06/17/2024 02:12:23 PM

Document Has Been Signed on 06/17/2024 02:12 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:DYNELL'S GUEST HOME #1FACILITY NUMBER:
361881216
ADMINISTRATOR/
DIRECTOR:		ROBINSON, CHARLESFACILITY TYPE:
735
ADDRESS:12423 FELIPE DRIVETELEPHONE:
(760) 955-9393
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 6CENSUS: 2DATE:
06/17/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Tessa Robinson- AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:22 PM
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Licensing Program Analyst (LPA) Michelle Echeverria made an unannounced collateral visit pertinent to complaint control number 56-AS-20240613153116 investigation that is unrelated to this facility. LPA met with Administrator, Tessa Robinson and explained the purpose of the visit.

During today's visit, LPA conducted a client's interview.

No deficiencies were cited during this visit. An exit interview was conducted, and a copy of this report was provided to Administrator, Tessa Robinson.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 06/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2024
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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