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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334811701
Report Date: 10/05/2023
Date Signed: 10/05/2023 10:10:57 AM


Document Has Been Signed on 10/05/2023 10:10 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
CCLD Regional Office, 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:108CENSUS: 26DATE:
10/05/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Elizabeth ZaragozaTIME COMPLETED:
10:25 AM
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On October 5, 2023, at 9:33 AM, Licensing Program Analysts (LPA's) Anastasia Flores and Tricia Danielson, arrived at the facility to conduct a Case Management inspection to inspect the newly remodeled classroom for the Preschool Programs and Transitional Kindergarten. LPAs met with Education Coordinator, Kimberley Byers, a tour was conducted by LPA's and Census was taken. Classroom was observed to be in compliance and the following was determined:

One of the State Preschool programs will be moved from room #1 to utilize room #26 in the afternoon. There is no change in capacity.

There are sufficient toilets and sinks to accommodate current capacity to accommodate the individual licensed programs.

Exit interview conducted, copy of this report, appeal rights and notice of site visit was reviewed and copies provided to Education Coordinator, Kimberly Byers.

Notice of Site Visit must be posted for 30 days.

SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Anastasia FloresTELEPHONE: (951) 533-2031
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2023
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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