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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426866
Report Date: 10/12/2023
Date Signed: 10/12/2023 01:50:38 PM

Document Has Been Signed on 10/12/2023 01:50 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:HELPING HEARTS VISCONTIFACILITY NUMBER:
366426866
ADMINISTRATOR:MANUAL SOTOFACILITY TYPE:
772
ADDRESS:1288 VISCONTI DRIVETELEPHONE:
(909) 260-8515
CITY:COLTONSTATE: CAZIP CODE:
92324
CAPACITY: 10CENSUS: 5DATE:
10/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:TIME COMPLETED:
02:00 PM
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Helping Hearts: Visconti Social Rehabilitation Facility unannounced to conduct an Annual Inspection. LPA knocked on the door and was greeted by Jhonathan Fajardo. LPA introduced self and stated purpose of the visit. LPA was granted entry and asked to sign in. Also, met and spoke with Program Director, Marie Lopez who provided LPA a walk through of the facility grounds.

LPA conducted a tour of the facility, inside and outside, and observed the following:

Facility: The Facility is approved for ten, (10) ambulatory residents. LPA Coleman observed that the facility is operating in the capacity and conditions approved by Community Care Licensing (CCL).
Physical Plant: LPA Coleman observed the facility's temperatures to be comfortable and measured the hot water temperature in the kitchen at 100 to 112 degrees. Showers and toilets are operable. Linens and hygiene items are sufficient for residents. Each room is equipped with lamps and appropriate lighting to ensure residents comfort and safety. The facility is equipped with smoke alarms, carbon monoxide detectors and are operable, and the facility was recently inspected by in October 2023. The Fire Department, determined that everything was safe and operating as required. LPA Coleman reviewed the facility's Emergency Disaster Plan and Fire Drills and observed that the facility last conducted a Fire Drill in October of 2023.
Food Service: Nonperishable and perishable food is sufficient for number of residents in care. Food is being prepared and stored properly. The facility food menu offers a variety of food available for residents.
Care & Supervision: Facility has sufficient care staff; toxic items are inaccessible to residents in care and stored and locked in hallway closet.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HELPING HEARTS VISCONTI
FACILITY NUMBER: 366426866
VISIT DATE: 10/12/2023
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Record Review and Resident/Staff Files: LPA Coleman reviewed records for five (5) residents currently living at the facility. Resident records are complete with updated physician reports and Needs and Services Plans. LPA Coleman additionally reviewed all four (4) staff files and confirmed that staff records reflect current CPR/First Aid Certification and Criminal Record Clearance. The Administrator's Administrator Certificate was observed to be in good standing.
Administration: Disaster Plan, Ombudsman poster, Administrator Certificate, Resident Rights, Let-Us-Know poster and facility license are posted in the hallway of the facility. Emergency Disaster Plan was also observed.
Medication/Medical Related Services: LPA Coleman observed that the residents' medication is centrally stored and locked in a file cabinet in the office. LPA Coleman reviewed all the residents' medications and compared it to the facility's Medication Administration Report (MARs) and Centrally Stored Medication Log. LPA Coleman did not observe any medication errors at this time.

No deficiencies were observed during this inspection. An exit interview conducted and copy of this report was provided to Facility Representative.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC809 (FAS) - (06/04)
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