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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426837
Report Date: 09/09/2024
Date Signed: 09/09/2024 01:58:37 PM

Document Has Been Signed on 09/09/2024 01:58 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:SVS SAN BERNARDINOFACILITY NUMBER:
366426837
ADMINISTRATOR/
DIRECTOR:		ANNA SILVAFACILITY TYPE:
775
ADDRESS:350 E. COMMERCIAL ROAD #114TELEPHONE:
(909) 255-8161
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92408
CAPACITY: 75CENSUS: 66DATE:
09/09/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Loretta Contreras-Case ManagerTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analysts (LPAs) Paola Guerrero and Beena Singh arrived at SVS-San Bernardino to conduct a collateral visit unrelated to current complaint 56-AS-20240905113538. LPAs explained to Case Manager Loretta Contreras the reason for the visit and explained that LPAs will be interviewing Client Dennise Garcia. During the visit LPAs were able to interview Client Dennise Garcia and obtain a statement pertaining to complaint # 56-AS-20240905113538.

An exit interview was conducted where this report (LIC809) was discussed, and a copy was provided to the Facility Loretta Contreras at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
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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