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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334805395
Report Date: 01/14/2020
Date Signed: 01/14/2020 03:54:01 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:ARMADA ELEMENTARY HEAD STARTFACILITY NUMBER:
334805395
ADMINISTRATOR:DARLENE MINJAREZFACILITY TYPE:
850
ADDRESS:25201 JOHN F KENNEDY DRIVETELEPHONE:
(951) 485-5886
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92551
CAPACITY:119CENSUS: 10DATE:
01/14/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Oxana Ackerson-Education CoordinatorTIME COMPLETED:
04:00 PM
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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 January 13, 2020.

Facility records were reviewed and client(s) Staff 1, Education Coordinator and Parents were interviewed. Further information will be needed. Upon completion of the review, the outcome and/or recommendations will be provided to the licensee.

An exit interview was conducted and a copy of this report was provided to facility staff.

SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2020
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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