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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334813280
Report Date: 06/12/2019
Date Signed: 06/12/2019 11:02:22 AM

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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:JOHN F. KENNEDY CHILD DEVELOPMENT CENTERFACILITY NUMBER:
334813280
ADMINISTRATOR:AMANDA ROSSIFACILITY TYPE:
840
ADDRESS:19125 SCHOOL HOUSE LANETELEPHONE:
(951) 780-1083
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY:70CENSUS: 56DATE:
06/12/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Amanda RossiTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA), Joanne Domingo and Licensing Program Manager (LPM), Telma Sandoval arrived at the facility on a case management visit to follow-up on an unusual incident report submitted by the facility on 6/06/19. At the time of visit, LPA toured the facility, took census, and met with Director - Amanda Rossi to discuss the reported incident. During the visit, LPA interviewed the subject children involved in the incident.

Based on the information obtained during the visit, as well as an inspection of the "cozy area", there appeared to be no violations of Title 22 Regulations pertaining to the reported incident.

An exit interview was held with Director - Amanda Rossi. A Notice of Site visit was issued, along with a copy of this report. This report shall be public record for three years.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2019
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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