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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334811930
Report Date: 02/26/2020
Date Signed: 02/26/2020 01:42:24 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:RSD-HARVEST VALLEY HEAD START AND STATE PRESCHOOLFACILITY NUMBER:
334811930
ADMINISTRATOR:VANESSA RODRIGUEZFACILITY TYPE:
850
ADDRESS:29955 WATSON ROADTELEPHONE:
(951) 928-2915
CITY:ROMOLANDSTATE: CAZIP CODE:
92585
CAPACITY:40CENSUS: 21DATE:
02/26/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Lead Teacher, Deisi VarelaTIME COMPLETED:
01:50 PM
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On 02/26/2020 at 12:35 PM, Licensing Program Analyst (LPA) Susan Brewer, arrived at the facility for the purpose of conducting a follow-up case management visit, in response to the receipt of an unusual incident report (UIR) from the facility. An initial visit took place on 02/14/2020. The UIR was received by the licensing agency on 02/11/2020, for an incident that took place on 02/10/2020 with the afternoon class. A census was taken of 21 children and 3 staff supervising.

A confidential Interview was conducted with Child #2. Further follow-up and information will be needed, due to other pertinent parties not present at the time of the visit and additional possible witnesses are not available to interview at this time. Upon completion of the review, the outcome and/or recommendations will be provided to the licensee. LPAs will return at a later date to complete the follow-up on the incident reported.

An exit interview was conducted by LPA S.Brewer, and a copy of this report was reviewed and provided to facility Staff Teacher Deisi Varela.

A Notice of Site Visit was issued on 02/26/2020, and must be posted in public view, for the next 30 days.
SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Susan BrewerTELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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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