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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426866
Report Date: 02/08/2024
Date Signed: 02/08/2024 01:30:18 PM

Document Has Been Signed on 02/08/2024 01:30 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: 8DATE:
02/08/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Damonyae Williams, BHTTIME COMPLETED:
01:32 PM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to deliver an amended report from 02/02/2024. LPA met with Damonyae Williams, behavioral health technician, and was informed of the purpose of today's visit. This case management visit is to deliver the amended report from 02/02/24 regarding Client 1 (C1) unauthorized absence.

On 01/31/2024, the San Bernardino Regional Office received an unusual incident report of C1's absence from the facility. The amended report from 02/02/24 states that the visit is in regards to a client's unauthorized absence from the facility.

No deficiency was cited during today's visit. An exit interview was conducted where this report was discussed and provided to Mr. Damonyae Williams.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/08/2024
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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