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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
334811530
Report Date:
05/16/2019
Date Signed:
05/16/2019 01:07:15 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:
SOUTH HILLS COMMUNITY CHURCH
FACILITY NUMBER:
334811530
ADMINISTRATOR:
GARCIA, NOGAH
FACILITY TYPE:
850
ADDRESS:
2585 S. MAIN STREET
TELEPHONE:
(951) 734-4141
CITY:
CORONA
STATE:
CA
ZIP CODE:
92882
CAPACITY:
120
CENSUS:
73
DATE:
05/16/2019
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:25 PM
MET WITH:
Nogah Garcia
TIME COMPLETED:
01:15 PM
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Licensing Program Analysts (LPAs) Taadhimeka Zeigler and Giselle Carbullido
arrived at the facility on a case management visit to follow-up on a Plan of Correction regarding Playground Supervision and AM/PM Transitions that was submitted to Community Care Licensing by the facility. Census was taken.
Staff were interviewed and were fully knowledgeable on the new procedure. There have not been any concerns or issues since its implementation.
No deficiencies are being cited at this time.
An exit interview was conducted and a copy of this report and a notice of site visit was provided to staff.
SUPERVISOR'S NAME:
Kimberly Williams
TELEPHONE:
(951) 248-0228
LICENSING EVALUATOR NAME:
Taadhimeka Zeigler
TELEPHONE:
(951) 680-6745
LICENSING EVALUATOR SIGNATURE:
DATE:
05/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
05/16/2019
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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