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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334802965
Report Date: 10/18/2021
Date Signed: 10/18/2021 12:41:51 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:UC RIVERSIDE CHILD DEVELOPMENT CENTERFACILITY NUMBER:
334802965
ADMINISTRATOR:KIMBERLY PIXLEYFACILITY TYPE:
830
ADDRESS:3333 WATKINS DRIVETELEPHONE:
(951) 827-3854
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY:54CENSUS: 2DATE:
10/18/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kimberly Pixley, Site SupervisorTIME COMPLETED:
12:45 PM
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On 10/18/211 at 11:00 AM , a case management visit was completed by Licensing Program Analyst (LPA) Giselle Carbullido during the course of another inspection at the facility. LPA was granted entry by Site Supervisor Kimberly Pixley. LPA toured the facility, reviewed records and took census.

Based upon LPA records reviews the following was observed and or discussed:

1) Reporting requirements: See LIC 9102 advisory

2) Facility has not had a COVID RAST Technical assistance visit. LPA conducted COVID RAST inspection today, provided resources: CDPH guidance's, facility COVID assessment and reporting procedures for COVID related incidents.

An exit interview was conducted, a copy of this report, appeal rights and Notice of Site Visit was provided to the Site Supervisor and the LPA observed the Notice of Site Visit form was posted. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THREE YEARS.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021
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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