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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530141
Report Date: 03/20/2025
Date Signed: 03/20/2025 12:41:13 PM

Document Has Been Signed on 03/20/2025 12:41 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:DESERT HORIZON RESIDENTIAL CARE IIFACILITY NUMBER:
365530141
ADMINISTRATOR/
DIRECTOR:		SHATTLES-BREEDLOVE, ANGELAFACILITY TYPE:
740
ADDRESS:13001 WALNUT WAYTELEPHONE:
(760) 953-5286
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 6CENSUS: 5DATE:
03/20/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 AM
MET WITH:Bria Sheriff- CaregiverTIME VISIT/
INSPECTION COMPLETED:
12:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Michelle Echeverria conducted an unannounced visit to this facility to initiate an investigation of complaint number: 56-AS-20250317111028. LPA met with Caregiver, Bria Sheriff.

During today's visit, LPA attempted to review and collect documents and was not able to since Administrator was out of town and staff present did not have access. Deficiency issued.

This poses a potential health and safety risk to residents in care. Refer to LIC 809D for deficiency cited.

An exit interview was conducted where this report, LIC809, LIC809D, and appeal rights were discussed with and provided to Caregiver, Bria Sheriff.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2025
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 03/20/2025 12:41 PM - It Cannot Be Edited


Created By: Michelle Echeverria On 03/20/2025 at 12:02 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: DESERT HORIZON RESIDENTIAL CARE II
FACILITY NUMBER: 365530141

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/24/2025
Section Cited
CCR
87755(c)

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87755(c) Inspection Authority of the Licensing Agency
(c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours....and 87508(b) This requirement is not met as evidenced by:
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Administrator stated that she will submit the requested records to the LPA via email by POC due date.
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Based on observation and interview, the administrator did not comply with the section cited above by not having records available for the LPA to audit and collect which poses a potential health, safety and personnal rights risk to persons in care.
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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 Brown
LICENSING EVALUATOR NAME:Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2025


LIC809 (FAS) - (06/04)
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