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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366408344
Report Date: 12/19/2023
Date Signed: 12/19/2023 02:49:55 PM

Document Has Been Signed on 12/19/2023 02:49 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:SWEET HAVEN IIFACILITY NUMBER:
366408344
ADMINISTRATOR:EMERSON ATIENZAFACILITY TYPE:
735
ADDRESS:9385 7TH AVENUETELEPHONE:
(760) 262-5933
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 6CENSUS: 4DATE:
12/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:39 PM
MET WITH:Zosimo Paulino, AdministratorTIME COMPLETED:
02:00 PM
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12/14/2023- Licensing Program Analyst (LPA) Amy Goldenberg attempted a case management visit on this date. There was no one at the home. LPA called telephone numbers on file to gain access to deliver an amended report. LPA was unable to reach any staff to come to the home. LPA attempted to contact Robert Castillones (760) 954-3689 (Administrator) and Zosimo Paulino (760)220-3631. (Co Administrator). There was no answer.

12/19/2023- LPA Goldenberg is conducting this case management visit to deliver an amended complaint investigation report pertaining to complaint investigation number 56-AS-20231106083210. This report along with the amended 9099 was reviewed with and provided to the facility representative.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2023
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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