<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366427604
Report Date: 09/09/2022
Date Signed: 09/09/2022 01:57:42 PM

Document Has Been Signed on 09/09/2022 01:57 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:COLE VOCATIONAL SERVICES HESPERIAFACILITY NUMBER:
366427604
ADMINISTRATOR:HIRES, SIMIENFACILITY TYPE:
775
ADDRESS:15075 MAIN STTELEPHONE:
(760) 998-2829
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 75CENSUS: 0DATE:
09/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Kaitlyn Simmons and Christina Diaz
Program Supervisors		TIME COMPLETED:
02:05 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Rayshaun Nickolas made an unannounced visit to the facility to commence a health and safety check. LPA Nickolas identified herself and discussed the purpose of the visit with Program Supervisors Kaityln Simmons and Christina Diaz due to the complaint control number 56-AS-20220908145243.

LPA observed no clients present during this visit. Inquiry into this incident included conducting a facility tour to assess for health and safety concerns. There were no health and safety concerns observed during this visit. Additional information will be required before the closure of this incident.

No deficiencies were cited during this visit. An exit interview was conducted where this report (LIC 809) was discussed and provided to Simmons and Diaz.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2022
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 1