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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334840476
Report Date: 09/12/2019
Date Signed: 09/12/2019 03:05:43 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:LAKE ELSINORE UNIFIED SCHOOL DISTRICT CHILDCAREFACILITY NUMBER:
334840476
ADMINISTRATOR:FRIEDA BRANDSFACILITY TYPE:
850
ADDRESS:520 CHANEY STREETTELEPHONE:
(951) 253-7000
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:29CENSUS: 23DATE:
09/12/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Vickie FluellenTIME COMPLETED:
03:00 PM
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LPA, Joanne Domingo arrived at the facility on a case management visit to follow-up on an unusual incident report submitted by the facility on 8/26/19. At the time of visit, LPA met with Teacher, Vickie Fluellen to discuss the reported incident.

It is alleged that on 8/12/19, a parent who was picking up their child had witnessed a staff member inappropriately mishandle another child. The following day, the parent disclosed that their own child had cried and the parent believes it is because of the same staff member. Child #1 is still currently enrolled at the facility while Child #2 has transferred to another facility.

Based on the information obtained during the visit there appeared to be no violations of Title 22 Regulations pertaining to the reported incident.

An exit interview was held with Teacher, Vickie Fluellen. A Notice of Site visit was issued, along with a copy of this report. This report shall be public record for three years.
SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2019
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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