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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334811701
Report Date: 03/13/2023
Date Signed: 03/13/2023 11:25:18 AM


Document Has Been Signed on 03/13/2023 11:25 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:SJUSD-HYATT HEAD START STATE PRESCHOOLFACILITY NUMBER:
334811701
ADMINISTRATOR:ZARAGOZA, ELIZABETHFACILITY TYPE:
850
ADDRESS:400 E. SHAVERTELEPHONE:
(951) 487-0526
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY:96CENSUS: DATE:
03/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kim Byers, Education CoordinatorTIME COMPLETED:
11:30 AM
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At 11:00AM on March 13, 2023, Licensing Program Analyst (LPA) Alaina Wilburn conducted a case management inspection and delivered amended reports that were initially provided to the facility on March 7, 2023.

No deficiencies were cited on this date. An exit interview was conducted, a Notice of Site Visit (LIC 9213) was posted, appeal rights were discussed and provided, and a copy of this report was given to Education Coordinator Kim Byers
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 217-5452
LICENSING EVALUATOR NAME: Alaina WilburnTELEPHONE: (951) 255-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/13/2023
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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