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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334811530
Report Date: 05/25/2023
Date Signed: 05/25/2023 09:55:51 AM


Document Has Been Signed on 05/25/2023 09:55 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:SOUTH HILLS COMMUNITY CHURCHFACILITY NUMBER:
334811530
ADMINISTRATOR:TINA BALLARDFACILITY TYPE:
850
ADDRESS:2585 S. MAIN STREETTELEPHONE:
(951) 734-4455
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY:120CENSUS: 46DATE:
05/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Tina BallardTIME COMPLETED:
10:00 AM
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On 5/25/2023, LPA Claudia Caywood and LPM Aaron Ross arrived at the facility to conduct a case management visit to document the delivery of an amended report dated 05/23/2023. The amended report was delivered 05/25/2023. During today's visit, LPA toured the inside and out of the facility, took census, and met with Site Director, Tina Ballard.

No deficiencies cited.

An exit interview was conducted, and a copy of this report was provided to current, Site Director, Tina Ballard.



A Notice of Site Visit was also provided and posted which must stay posted for 30 days.

THIS REPORT MUST BE AVAILABLE TO THE PUBLIC, UPON THEIR REQUEST, FOR THREE YEARS
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4800
LICENSING EVALUATOR NAME: Claudia CaywoodTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 05/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/25/2023
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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