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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366408344
Report Date: 11/07/2023
Date Signed: 11/07/2023 11:38:40 AM


Document Has Been Signed on 11/07/2023 11:38 AM - 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:SWEET HAVEN IIFACILITY NUMBER:
366408344
ADMINISTRATOR:EMERSON ATIENZAFACILITY TYPE:
735
ADDRESS:9385 7TH AVENUETELEPHONE:
(909) 641-8579
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:6CENSUS: 4DATE:
11/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Zosimo Paulino, Administrator
Robert Castillones, Administrator		TIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Amy Goldenberg is conducting this case management visit in conjunction with complaint investigation control number 56-AS-20231106083210 to address any violations not related to the investigation.

Upon arrival to the facility at 0915 LPA was unable to gain access to the property due to there being chains and padlocks on all of the perimeter fencing. There were three padlocks observed, one of which was on the gate which was an exit from the back yard and part of the facility evacuation plan and two perimeter driveway gates along with chains. Pictures obtained. LPA made several attempts to contact the facility by the phone number on file and was unsuccessful. LPA contacted staff at another facility, Sweet Haven III and they provided LPA with an additional contact number for this location. LPA eventually was able to speak to Zosimo Paulino, Administrator who provided LPA with the number of Administrator Robert Castillones who was present in the home. LPA eventually made contact and was granted entry into the property only after the locks and chains were removed. Upon entry LPA learned there is one resident home along with Administrator Castillones. Having a locked perimeter is a fire clearance violation and poses an immediate risk to the health and safety of individuals on the premises.

LPA reviewed this report with and provided copies of LIC809, LIC809D, Civil Penalty, and appeal rights prior to exiting the location.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amy GoldenbergTELEPHONE: (951) 201-3990
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2023
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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Document Has Been Signed on 11/07/2023 11:38 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507


FACILITY NAME: SWEET HAVEN II
FACILITY NUMBER: 366408344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/07/2023
Section Cited
CCR
80020(a)(2)

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All facilities shall secure and maintain a fire clearance approved by the city or county fire department...Prior to the use of secured perimeters, an applicant or licensee for an Adult Residential Facility or Group Home shall meet the fire clearance approval requirements of Title 17...
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Facility Administrators agree to immediately remove any locks and cease use of locked perimeters.
Licensee to provide a statement of understanding of regulation section cited by POC due date.
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The facility did not meet this requirement as evidenced by LPA observation of padlocks and chains on the surrounding fencing. This poses an immediate risk to the health and safety of anyone on the premesis.
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A civil penalty accompanies this deficiency.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amy GoldenbergTELEPHONE: (951) 201-3990
LICENSING EVALUATOR SIGNATURE:
DATE: 11/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/07/2023
LIC809 (FAS) - (06/04)
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