334830147-12-22-2022-09-CC-GCAO-CMCQLU-20221222111632

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334830147
Report Date: 12/22/2022
Date Signed: 12/22/2022 11:16:39 AM

Document Has Been Signed on 12/22/2022 11:16 AM - 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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	YOUNG SCHOLAR EDUCATION CENTER		FACILITY NUMBER:	334830147
ADMINISTRATOR:	ROSA PEREZ		FACILITY TYPE:	850
ADDRESS:	4029 W. GEORGE STREET		TELEPHONE:	(951) 849-5608
CITY:	BANNING	STATE: CA	ZIP CODE:	92220
CAPACITY: 72	TOTAL ENROLLED CHILDREN: 72	CENSUS: 14	DATE:	12/22/2022
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Rosa Perez Director/Owner		TIME COMPLETED:	10:00 AM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

A case management 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 12/20/2022.

Facility records were reviewed and staff interviews conducted. Further information will be needed. Upon completion of the review, the outcome and/or recommendations will be provided to the Director Licensee

An exit interview was conducted and a copy of this report and appeal rights were provided to the Director.

Gilbert Sena
Giselle Carbullido
	DATE: 12/22/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 1