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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330900323
Report Date: 09/09/2021
Date Signed: 09/09/2021 02:55:49 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:FIRST UNITED METHODIST CHURCH PRESCHOOLFACILITY NUMBER:
330900323
ADMINISTRATOR:KAREN WILSONFACILITY TYPE:
850
ADDRESS:4845 BROCKTONTELEPHONE:
(951) 683-4500
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:78CENSUS: 38DATE:
09/09/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:08 AM
MET WITH:Director, Karen WilsonTIME COMPLETED:
03:05 PM
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On 09/09/2021 at 11:25am, Licensing Program Analysts (LPAs) Destinee Hogue and Laura Mejorado conducted a case management inspection with Director, Karen Wilson. A case management inspection is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 09/02/2021.

During this inspection, LPAs toured the facility inside and outside, took census of daycare children present on this date, interviewed staff and children, reviewed records, and discussed the following with Director, Karen Wilson.

At this time, further information will be needed and upon completion of the review, the outcome and/or recommendations will be provided to the Director.

LPAs conducted an exit interview with Director and provided a copy of this report. LPA issued a Notice of Site Visit and verified it was posted in a prominent location at the facility prior to leaving the facility. Director understands that the Notice of Site Visit must remain posted for the next 30 days.



No deficiencies were cited during this tele-inspection.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
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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