334805317-8-30-2022-09-CC-GCAO-CHSTEN-20220830144014

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334805317
Report Date: 08/30/2022
Date Signed: 08/30/2022 02:40:17 PM

Document Has Been Signed on 08/30/2022 02:40 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	TEMPLE BETH EL CHILD DEVELOPMENT CENTER		FACILITY NUMBER:	334805317
ADMINISTRATOR:	TRUDY J OLIVER		FACILITY TYPE:	840
ADDRESS:	2675 CENTRAL AVE		TELEPHONE:	(951) 682-7282
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92506
CAPACITY:	62	CENSUS: 0	DATE:	08/30/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Trudy Oliver, Administrative Director		TIME COMPLETED:	02:37 PM

NARRATIVE

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A case management visit 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 08/19/22. LPA was granted access into the facility and met with Administrative Director, Trudy Oliver. LPA toured facility and took a census. There were no children present during the visit due to being at public school.

Facility records were reviewed, and staff interviews conducted. Further information will be needed. Upon completion of the review, the outcome and/or recommendations will be provided to the Facility Representative.

Due to insufficient information at this time, LPA will need to return at a later date to deliver the final report.

An exit interview was conducted, and a copy of this report, notice of site visit and appeal rights were provided to the Administrative Director.

Notice of Site Visit must be posted for 30 days.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle Carbullido	TELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

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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