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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334812348
Report Date: 11/17/2022
Date Signed: 11/17/2022 12:05:23 PM


Document Has Been Signed on 11/17/2022 12:05 PM - 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:RCOE-PERRIS HEAD START STATE PRESCHOOL EARLY HEADFACILITY NUMBER:
334812348
ADMINISTRATOR:CYNTHIA BERUMENFACILITY TYPE:
830
ADDRESS:148 AVOCADO AVENUETELEPHONE:
(951) 826-7200
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:63CENSUS: 26DATE:
11/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Cynthia BerumanTIME COMPLETED:
12:15 PM
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On date and time listed, Licensing Program Analyst (LPA) Sumayya Habeebulla arrived at the facility to conduct a Case Management visit at the request of the Site Supervisor Ms. Cynthia Berument. LPA toured the facility inside and out with Ms. Berumen.

LPA toured the playground and new equipment with Ms. Berumen. The play structure is new and in good condition. The cushioning material is rubber matting, and the play structures have a a structural cover for shade over them. There is 1 free standing water fountain in working condition and facility will continue providing portable water and drinking cups for outdoor activity. The entire outdoor play area is fenced as per Title 22 regulations. The area was previously measured during the pre-licensing visit on 01/23/2003 and therefore LPA did not remeasure today for the report. The Playground area measurement has not changed from 01/23/2003 as per Ms. Berumen..

NO DEFICIENCIES WERE CITED DURING THIS VISIT.

An exit interview was conducted, and this report was reviewed with the Site Supervisor Ms. Cynthia Berumen. Appeal rights were discussed and provided during the exit interview.



A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Sumayya HabeebullaTELEPHONE: 951-201-1991
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022
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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