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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802301
Report Date: 08/20/2020
Date Signed: 08/20/2020 01:55:33 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:A HEAVENLY HOME COMMUNITIES CFACILITY NUMBER:
405802301
ADMINISTRATOR:JIMENEZ, JENNIFER RFACILITY TYPE:
740
ADDRESS:2029 UNION ROADTELEPHONE:
(310) 889-8586
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:6CENSUS: 5DATE:
08/20/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jennifer Jiminez/LicenseeTIME COMPLETED:
01:47 PM
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 At 12:50pm on 08/20/2020, Licensing Program Analyst (LPA) Mark Jeffries initiated a Case Management Visit for the Incident repot dated from this facility 08/18/2020. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s case management visit was conducted telephonically with Jennifer Jiminez, the facility Administrator and Licensee.
LPA confirmed with Licensee that staff in question (S1) was on their first day working at the facility. After 4 hours of shadowing with two teaching staff (S2 and S3), S1 took a break outside of the facility. When S1 returned back into the facility from their break, S2 noticed a bulge of a hypodermic needle in S1's sock/shoe area. S2 immediately called Licensees. Licensee Marco Jiminez contacted Paso Robles Police Department. Licensee Marco Jiminez arrived at facility within 5 minutes of the call from S2. Licensee begin and completed processing termination paperwork for S1. Paso Robles Police Department escorted S1 off the facility property. Once outside the fence of the facility property Paso Robles Police Officers administered test to S1 and then arrested S1 according to Licensee.


Report emailed to Licensee.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2020
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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