Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330909315
Report Date: 12/09/2016
Date Signed: 12/09/2016 02:12:23 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:V.I.P. TOTSFACILITY NUMBER:
330909315
ADMINISTRATOR:KAREN CALVILLOFACILITY TYPE:
850
ADDRESS:41861 E. ACACIA AVENUETELEPHONE:
(951) 652-7611
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:86CENSUS: 0DATE:
12/09/2016
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Karen CalvilloTIME COMPLETED:
02:20 PM
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Licensing Program Analysts (LPAs) Kimberly Williams and Sharleen Robinson arrived at the facility for a visit initiated by the Facility Site Manager, Debbie Haney. The purpose of today's visit is to provide All Staff Training for facility employees. Today's training covered various subjects, related to Title 22 Regulations, such as supervision, violation types, personal rights, ratios, and reporting requirements; including new legislation and Community Care Licensing (CCL) updates.

There were no children present during today's visit, the facility closed at 12:00 pm for this All Staff training.

Exit interview conducted and a copy of this report was left at the facility.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Anita HiseTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Kimberly WilliamsTELEPHONE: (951) 680-6841
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2016
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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