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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334820503
Report Date: 12/06/2019
Date Signed: 12/06/2019 06:05:51 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:FREEDOM CREST CHILD DEVELOPMENT CENTERFACILITY NUMBER:
334820503
ADMINISTRATOR:ANA ROMEROFACILITY TYPE:
840
ADDRESS:29282 MENIFEE ROADTELEPHONE:
(951) 679-6103
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY:70CENSUS: 19DATE:
12/06/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:36 PM
MET WITH:Site Supervisor Ana RomeroTIME COMPLETED:
06:15 PM
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ON 12/06/2019 at 4:36 PM, Licensing Program Analyst (LPA) Susan Brewer, arrived at the facility for the purpose of a case management review. This review/visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 11/13/2019.

Facility records for both children and staff were reviewed. The individuals reported on the UIR to be involved, were not present at the facility to interview on 12/06/2019. Staff #1 was not working. Child #1 and Child #2, left for the day. Further information will be needed. Upon completion of the review, the outcome and/or recommendations will be provided to the licensee Site Director Ana Romero.

The LIC811 was provided to the Facility Director, documenting the confidential names list of staff and children's records reviewed.

No violations or citations were issued on 12/06/2019.

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.

An exit interview was conducted with Site Director Ana Romero, and a copy of this report was provided on 12/06/2019, and must be made available to the public upon request for the next 3 years.
SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Susan BrewerTELEPHONE: (951) 970-0343
LICENSING EVALUATOR SIGNATURE:

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

DATE: 12/06/2019
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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