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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426866
Report Date: 10/23/2024
Date Signed: 10/23/2024 02:43:16 PM

Document Has Been Signed on 10/23/2024 02:43 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HELPING HEARTS VISCONTIFACILITY NUMBER:
366426866
ADMINISTRATOR/
DIRECTOR:		MANUAL SOTOFACILITY TYPE:
772
ADDRESS:1288 VISCONTI DRIVETELEPHONE:
(909) 260-8515
CITY:COLTONSTATE: CAZIP CODE:
92324
CAPACITY: 10CENSUS: 9DATE:
10/23/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Valerie Daniels, Supervising Program DirectorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 10/23/2024 at 12:45 PM, Licensing Program Analysts (LPAs) Eldin Serrano and Sarina Ramirez conducted an unannounced visit to the facility to conduct the required comprehensive annual inspection to the facility. LPAs were greeted by Supervisor Program Director Valerie Daniels and gained access at the home. LPAs explained the purpose of the visit to Supervisor Program Director Daniels .

The facility has five (5) bedrooms, two (2) bathrooms, kitchen, dining rooms, living rooms, and backyard. The facility is licensed for 10 of which can be non-ambulatory. LPAs completed a walk through of the facility, review of records, Personal and Incidental (P&I) and medications audit.



Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD), LPAs observed eight (8) clients during the visit. There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 71 degrees Fahrenheit. LPAs inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs, and sufficient lighting. LPAs inspected client bathrooms; bathrooms were clean, and appliances were found functional. LPAs observed that the water temperature in the bathroom to be 110 degrees Fahrenheit. The facility is equipped with operational combined smoke detectors and carbon monoxide detectors, charged fire extinguishers, and first aid kit.

Posters such as the personal rights and emergency disaster plan were posted in a common area. Client medications were kept in secure cabinets inaccessible to clients. LPAs observed night lights at the hallway leading to clients' shared bathrooms. The facility had emergency kits, emergency food and water. There are no firearms and ammunition in the facility.
*** Continuation in LIC809C ***
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HELPING HEARTS VISCONTI
FACILITY NUMBER: 366426866
VISIT DATE: 10/23/2024
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Yards/Outside: Backyard and all outdoor pathways were free of obstructions.

Food Service: LPAs Serrano and Ramirez observed two (2) day(s) supply of perishable food and seven (7) day(s) supply of non-perishables food and snacks. Dishes, cups, and utensils were stored properly.


Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week.

Record Review: LPAs reviewed four (4) client files for admission agreements, medical assessments/physician reports, and Individual Program Plan (IPP). LPAs observed files reviewed were complete. LPAs also reviewed four (4) staff for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test result.

LPAs audited four (4) clients’ medications and no issues were observed. LPAs audited four (4) client's Personal and Incidental (P&I) and no issues observed.

No deficiencies were cited during this visit. An exit interview was conducted where this report LIC809 was discussed, and copies were provided to Supervisor Program Director Valerie Daniels.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
LIC809 (FAS) - (06/04)
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