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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334819356
Report Date: 01/20/2022
Date Signed: 01/20/2022 04:43:11 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:CROSSROADS CHRISTIAN PRESCHOOLFACILITY NUMBER:
334819356
ADMINISTRATOR:MORRISON, PENNYFACILITY TYPE:
850
ADDRESS:2380 FULLERTON AVENUETELEPHONE:
(951) 278-3196
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY:252CENSUS: 11DATE:
01/20/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Assistant Director Monique GarciaTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Samuel Lopez arrived at the facility to conduct a case management visit in response to the receipt of an unusual incident report (UIR). The UIR was received by the licensing agency on 1/10/2022. The UIR documented an incident involving inappropriate behavior between children in care.

Upon arrival, LPA Lopez met with facility Assistant Director Monique Garcia and stated the purpose of the visit. Facility was toured, specifically the classroom where the incident occurred, and a census was taken of the children present. Not all children involved in the incident were present at the facility, at the time of visit. Records were reviewed and interviews were conducted.

Based on the observations made and information gathered, there were no violations of Title 22 identified, at this time.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the Assistant Director Monique Garcia.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:

DATE: 01/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2022
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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