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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366402294
Report Date: 10/11/2023
Date Signed: 10/11/2023 01:05:34 PM

Document Has Been Signed on 10/11/2023 01:05 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:COLE VOCATIONAL SERVICES VICTORVILLEFACILITY NUMBER:
366402294
ADMINISTRATOR:COX, BRANDONFACILITY TYPE:
775
ADDRESS:16519 VICTOR STTELEPHONE:
(760) 962-9111
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 120CENSUS: 96DATE:
10/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:02 PM
MET WITH:Erin Bomgaars- Program ManagerTIME COMPLETED:
01:16 PM
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Licensing Program Analyst (LPA) Michelle Echeverrria conducted an unannounced case management visit to follow up on an incident report sent to licensing dated on 09/19/23. LPA was greeted and explained the reason for the visit to Program Manager, Erin Bomgaars.

Per the incident report, after Staff (S1) picked up (C1) from home, (C1) informed (S1) that (C1) care provider partner was verbally abusive towards (C1). During today's visit, it was discovered that Cole Vocational Services Victorville reported the issue to APS and (C1) was removed from the old facility and is living at a new facility. At the moment, the issue is still being investigated at Cole Vocational Services Victorville.

No deficiencies were observed during this visit. An exit interview was conducted where this report was, reviewed, discussed and then provided to Program Manager, Erin Bomgaars.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2023
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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