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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334819449
Report Date: 08/27/2021
Date Signed: 08/27/2021 01:45:27 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:GROVE COMMUNITY CHURCH PRESCHOOLFACILITY NUMBER:
334819449
ADMINISTRATOR:CATHY HARMONFACILITY TYPE:
850
ADDRESS:19900 GROVE COMMUNITY DRIVETELEPHONE:
(951) 571-9080
CITY:RIVERSIDESTATE: CAZIP CODE:
92508
CAPACITY:210CENSUS: 50DATE:
08/27/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Cathy HarmonTIME COMPLETED:
01:50 PM
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On 8/27/21, Licensing Program Analyst, Laura Mejorado arrived at the facility to conduct a Case Management inspection to amend the complaint investigation report that was issued to the facility on 8/26/2021. LPA toured the facility, took census and met with Director Cathy Harmon.

Additional information is being added to the LIC9099 and LIC9099C, however there are no changes to the unsubstantiated findings.

An exit interview was held with Director.

The Notice of Site Visit (LIC 9213) shall be posted where the parent/guardian of children enter and exit the facility. The Notice of Site Visit (LIC 9213) must remain posted for 30 days during the hours of operation after each site visit by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

A copy of this report must be made available for 3 years
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Laura MejoradoTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021
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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