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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334830640
Report Date: 01/09/2024
Date Signed: 01/09/2024 03:17:59 PM


Document Has Been Signed on 01/09/2024 03:17 PM - 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:KIDD STREET PRESCHOOL OF RIVERSIDEFACILITY NUMBER:
334830640
ADMINISTRATOR:MARIA TEELFACILITY TYPE:
840
ADDRESS:10250 KIDD STREETTELEPHONE:
(951) 688-4242
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY:47CENSUS: 10DATE:
01/09/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Jeni GonzalezTIME COMPLETED:
03:15 PM
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On this date and time, Licensing Program Analyst (LPA) Giselle Carbullido arrived at the facility to conduct a Case Management inspection regarding a Decision and Order (D&O), which was ordered on December 27, 2023, and has become effective beginning January 08, 2024. The Decision and Order is regarding the exclusion of Jillian Palmer aka Jillian Sadasha Palmer who was employed or sought employment at the facility. The purpose of the inspection was explained to Facility representative Jeni Gonzalez. LPA toured the facility and took a census. The subject, Jillian Palmer was not observed at the facility and their last date of employment with this facility was 03/12/2019.

A copy of the Decision and Order was mailed out to the Respondent and facility on 12/28/2023. An additional copy was provided to the Executive Director, Jeni Gonzalez during today’s inspection. Executive Director acknowledged receipt and understanding of the Decision and Order which reads: “Respondent Jillian Palmer is prohibited from employment in, presence in, and contact with clients of, any facility licensed by the Department, certified or approved by a licensed foster family agency, or any resource family home, and from holding the position of member of the board of directors, executive director, or officer of the licensee of any facility licensed by the Department, for the remainder of Respondent’s life.”

No deficiencies cited during today’s inspection.

A notice of site visit was provided to facility representative Jeni Gonzalez and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 consecutive days.

An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Jeni Gonzalez. A copy of this report must be made available to the public upon request for three years.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024
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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