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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842393
Report Date: 02/21/2020
Date Signed: 04/28/2020 09:46:37 AM

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:PHILLIP M STOKOE HEAD STARTFACILITY NUMBER:
334842393
ADMINISTRATOR:BARBARA ESTHERFACILITY TYPE:
850
ADDRESS:4501 AMBS DRIVETELEPHONE:
(951) 826-4390
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:59CENSUS: 0DATE:
02/21/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Barbara EstherTIME COMPLETED:
09:15 AM
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On the date and time listed above, a case management visit was conducted by Licensing Program Analyst (LPA) Giselle Carbullido to deliver an amended report. During today’s visit, LPA toured the facility and census was taken, with no children present. LPA met with Barbara Esther, Director to deliver amended report.

Exit interview conducted and a copy of this report and notice of site visit was provided to the Licensee. A copy of this report must be made available to the public for 3 years.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2020
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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