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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330907476
Report Date: 09/27/2021
Date Signed: 09/27/2021 09:16:36 AM

Document Has Been Signed on 09/27/2021 09:16 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:OCS ST. HYACINTH ACADEMY PRESCHOOLFACILITY NUMBER:
330907476
ADMINISTRATOR:LINDA CAMPINGFACILITY TYPE:
850
ADDRESS:600 S. SANTA FE AVENUETELEPHONE:
(951) 654-2013
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY: 35TOTAL ENROLLED CHILDREN: 0CENSUS: 18DATE:
09/27/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Karla CortezTIME COMPLETED:
09:30 AM
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Licensing Program Analyst Alaina Wilburn conducted an unannounced case management visit. LPA met with Director Karla Cortez. The purpose of the visit is to ensure the facility is following COVID-19 protocols.

The facility was closed due to COVID-19 from March 17. 2020 through August 20, 2021. The Director submitted an Unusual Incident Report advising that the school planned to reopen on August 23, 2021. The COVID-19 Self Assessment along with posters and supportive information was forwarded to the Director, and Mrs. Cortez returned the completed Self-Assessment to the RROSE Community Care Licensing office.

During today's visit, LPA toured facility and verified COVID-19 posters are posted in designated areas. LPA observed all staff and children to be wearing mask. LPA discussed COVID-19 posters, self-assessment and on-going expectations.

A copy of this report was provided to the Director on this date and must be made available to the public upon request for the next 3 years. Exit interview conducted.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE DIRECTOR UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS
Stephanie Hudak
Alaina Wilburn
DATE: 09/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2021
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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