<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842140
Report Date: 08/09/2022
Date Signed: 08/09/2022 02:36:30 PM


Document Has Been Signed on 08/09/2022 02:36 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:FSA-CABAZON CDCFACILITY NUMBER:
334842140
ADMINISTRATOR:MARY HAMPTONFACILITY TYPE:
830
ADDRESS:50390 CARMEN AVENUETELEPHONE:
(951) 846-8900
CITY:CABAZONSTATE: CAZIP CODE:
92230
CAPACITY:23CENSUS: 0DATE:
08/09/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lizeth Ouellette, Cheryl Hansberger, May EslavaTIME COMPLETED:
02:30 PM
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
On this date and time, an Informal Conference was held in the Riverside Child Care Regional Office. Present in the conference were Site Director, Lizeth Ouellette; Chief Executive Officer (CEO), Cheryl Hansberger; Chief Operating Officer (COO), May Eslava; Licensing Program Manager (LPM) Kimberly Williams and Licensing Program Analysts (LPAs) Blanca Ruiz and Aman Sharma.

The conference was called to discuss the following:

1. Responsibility for Providing Care and Supervision for Infants

Licensee's compliance history was reviewed during this conference. Licensee's responsibilities and accountability were also reviewed with the licensee during this conference. LPM Williams reminded Licensee of how important regulatory compliance is in licensed facilities to protect the Health and Safety of children (Infants) in care. Licensee has been informed the licensing agency takes noncompliance meetings seriously, and how repeat violations can lead to a Non-Compliance Conference and/or the Department seeking legal consultation regarding the status of the license.

During today's conference, the following documents were discussed and provided to Director/Licensee: Title 22 Regulations, section(s) 101429 Responsibility for Providing Care Supervision for Infants, 101212 Reporting Requirements and the Quarterly Update for Summer 2022. Contact information for the local Resource and Referral Agency, Riverside County Office of Education (RCOE) at (951) 826-6530 and Community Care Licensing (CCL) Child Care Advocates (916) 654-1541 was provided to the Director.
Licensee agrees to ensure that the facility is operating in substantial compliance of California Code of Regulations Title 22, Division 12, Chapter 1. Licensee was advised to visit the Department's website at https://cdss.ca.gov/inforesources/child-care-licensing/resources-for-providers
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-SilvaTELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2022
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: FSA-CABAZON CDC
FACILITY NUMBER: 334842140
VISIT DATE: 08/09/2022
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
26
27
28
29
30
31
32
on a regular basis for licensing updates, self-assessment tools, quarterly updates, and Provider Information Notices (PIN). These resources are suggested and provided to the Licensee as technical support, in efforts of assisting the provider with sustainable future compliance. Licensee is also advised to contact the duty officer at (951) 782-4200 for any questions or concerns that may arise, the duty officer is available Monday – Friday (8:00 am to 5:00 pm). Exit interview was conducted with facility representatives. A copy of this report was provided to the Site Director, Lizeth Ouellette. This report must be made available to the public upon request for the next 3 years.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-SilvaTELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2