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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334805395
Report Date: 01/21/2020
Date Signed: 01/21/2020 11:01:10 AM

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: 99DATE:
01/21/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Oxana Ackerson-Education CoordinatorTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) La Kesha Edwards made an unannounced visit to the facility on January 13, 2020, and met with Oxana Ackerson-Education Coordinator. A case management visit was conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was called in to the licensing agency on January 13, 2020 indicating the child had walked out of the classroom to the school parking lot, however when the LIC 624B form was received by the licensing agency on January 14, 2020. It indicated a child had been observed by a parent to be in the parking lot by the head start building and had exited the gate while the children were being lined up to return to the classroom unsupervised on January 13, 2020.

Facility records were reviewed, and staff, parents and the child were interviewed. Based on the information gathered, facility staff did not meet the Responsibility for Providing Care and Supervision. See complaint received on January 14, 2020 for further details.


An exit interview was conducted, and a copy of this report was provided to Oxana Ackerson-Education Coordinator.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Lakesha EdwardsTELEPHONE: (951) 970-4412
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2020
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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