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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426866
Report Date: 10/13/2022
Date Signed: 10/13/2022 03:48:09 PM

Document Has Been Signed on 10/13/2022 03:48 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:HELPING HEARTS VISCONTIFACILITY NUMBER:
366426866
ADMINISTRATOR:MANUAL SOTOFACILITY TYPE:
772
ADDRESS:1288 VISCONTI DRIVETELEPHONE:
(909) 260-8515
CITY:COLTONSTATE: CAZIP CODE:
92324
CAPACITY: 10CENSUS: 9DATE:
10/13/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:Christopher LarryTIME COMPLETED:
03:49 PM
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On this day at 2:06 PM, Licensing Program Analysts (LPAs) Anna Bueno and Amber Coleman conducted an unannounced visit to the facility to conduct a case management visit and follow up on an adult client death. LPAs were not able to gain entry to the home and phoned administrator Christopher Larry who was explained the purpose of today's visit. LPAs met with Mr. Larry, Blythe McClanahan, and Kathy Boyle at 2:28 PM and LPAs were allowed in the facility.

This case management visit consisted of collecting pertinent documentation and conducting staff interviews in regards to the death of Client #1 (C1). LPA interviewed Staff #1 (S1) and Staff #2 (S2) for further information in regards to the death of C1 and the events that led up to C1's death. S1 stated that no official death certificate or reason for death at this time, per the Coroner's office. LPA has advised the Administrator to send a copy of the death certificate the Community Care Licensing Division (CCLD) Riverside Regional Office as soon as it is available.

During today's visit, LPAs observed two third party contractors were replacing the tile in bathroom due to a plumbing issue. Additionally, LPAs observed three laundry detergent
bottles placed on the floor. Technical violations (TVs) are being issued for aforementioned concerns due to clients not being present in the facility.

An exit interview was conducted where this report and LIC9102TV were discussed and provided to the Administrator.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2022
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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