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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530027
Report Date: 08/01/2022
Date Signed: 08/01/2022 02:24:43 PM

Document Has Been Signed on 08/01/2022 02:24 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:VALLEY HOME IIFACILITY NUMBER:
365530027
ADMINISTRATOR:MIGUEL, CRISELDAFACILITY TYPE:
735
ADDRESS:1256 MORRISON DRIVETELEPHONE:
(909) 798-1650
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY: 4CENSUS: 3DATE:
08/01/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Applicant/Administrator Artemio DirigeTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Melody Brown conducted an announced Prelicensing visit 08/01/2022 at 01:50 PM. This is an announced Pre-Licensing visit conducted with Applicant/Administrator Artemio Dirige who assisted in the tour of inside and outside of facility and the evaluation. LPA Melody Brown made a second (2nd) announced prelicensing visit this date. The follow up visit was made to confirm that all corrections have been made.

The following: “Obtain and post Let-Us-No Poster, Obtain and post an Ombudsman poster (will pick-up on 08/03/2022), Obtain and post Labor Laws, Print and Post Covid-19 Signages in the common areas of the facility, Visitor Vaccination Verification Log, Pull-out two (2) broken wheelchairs at the backyard, Pull-out broken gutter at the backyard, Dispose recyclable empty bottles in the garage and boxes, Obtain one (1) Stand up Light for bedroom # 4” All were found to be corrected.

The facility was evaluated in accordance with the CCR, Title 22 California Code of Regulations. Based on the observations and evaluation of the facility this date, the facility’s ready for licensure.

Applicant/Administrator will be notified once facility is licensed.

An exit interview was conducted, and a copy of this report (LIC809) was discussed and provided with Applicant/Administrator Artemio Dirige.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2022
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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