Report a Concern Form
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  • Report a Concern

  • Purpose Statement

    At 360 Human Services, we are deeply committed to maintaining the highest standards of ethical, legal, and compliant operations. We believe that every member of our team—staff, contractors, interns, and volunteers—plays a vital role in upholding these values.

    This page provides a safe and confidential way for you to report any concerns related to compliance, ethics, or safety without fear of retaliation. Your voice matters, and all reports submitted here are taken seriously and reviewed promptly by our Compliance Officer, Yamile Gomez.

    We encourage you to speak up if you observe any issues or irregularities. Together, we can ensure a trustworthy, respectful, and supportive environment for everyone at 360 Human Services.

  • Critical Client Information Instructions

    DO NOT include any client’s full name, date of birth, address, or any other identifying information in this form.

    If your report involves a specific client, please use the client’s initials only.
    A member of the 360 Human Services compliance team will contact you directly to collect any additional client information needed in a secure and compliant manner.

    If you are submitting anonymously, use initials only — do not include any details that could identify the client.

  • Report Type*
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  • Critical Client Information Instructions Reminder

    Use client initials only. Do NOT include full names, dates of birth, or any other identifying information.

  • Have you already reported this concern to a supervisor?*
  • Submitting Anonymously?*

  • Important Disclaimer

    Submitting a report through this page does NOT relieve you of your ndividual legal duty to report under California’s Mandated Reporting Law (CANRA).

    If you have a reasonable suspicion of child abuse or neglect, you are still required to call CPS directly and complete the SCAR Form SS 8572 within the legally required timeframes — regardless of whether you have also submitted a report here.

    Reporting internally to 360 Human Services is NOT a substitute for your personal legal obligation.

  • Anonymity Notice

    360 Human Services will make every effort to protect the identity of individuals who submit anonymous reports. However, please be aware that in the event of a legal investigation, regulatory audit, or court proceeding, form submissions may be subject to subpoena. Complete anonymity cannot be legally guaranteed.

    Contact Directory

    • Compliance Officer – Yamile Gomez | arroyogomez@360humanservices.com | 442-284-5777
    • HR Director – Sharitha Pope | hr@360humanservices.com (General compliance, employment, and HIPAA concerns)
    • Clinical Director – Julie Mominee | jmominee@360humanservices.com (Clinical documentation, supervision, and ethics concerns)

    Mandated Reporting Resources

    • San Bernardino County CPS: 1-800-827-8724
    • Riverside County CPS: 1-800-442-4918
    • SCAR Form SS 8572 (link or file to be provided

    Anti-Retaliation Notice

    No employee, contractor, intern, or volunteer will face retaliation for reporting a concern in good faith, in accordance with California Labor Code § 1102.5.
    Any act of retaliation is a serious compliance violation and will result in disciplinary action, up to and including termination.

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