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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843562
Report Date: 02/16/2023
Date Signed: 02/16/2023 04:39:33 PM


Document Has Been Signed on 02/16/2023 04:39 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:RCOE - CASA BLANCA HEAD STARTFACILITY NUMBER:
334843562
ADMINISTRATOR:NATILEE CARTERFACILITY TYPE:
850
ADDRESS:7711 CASA BLANCA STREETTELEPHONE:
(951) 826-7275
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:47CENSUS: 17DATE:
02/16/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Specialist Heather Arnold and Coordinator Deo Thomas TIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Samuel Lopez arrived at the facility to conduct a case management visit in response to the receipt of an unusual incident report (UIR). The UIR was received by the licensing agency on 2/10/2023. The UIR documented an incident in which a child alleged that a Teacher may have hit the child on the hand.

Upon arrival this date on 2/16/2023, LPA Lopez met with Specialist Heather Arnold and then Coordinator Deo Thomas stated the purpose of the visit. Records were reviewed and interviews were conducted. Although the subject child was not present at time of visit and based on the information gathered, facility complied with reporting requirements, and other regulation requirements.

No violations of Title 22 were identified, at this time.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.



Exit interview conducted and report was reviewed with the Specialist Heather Arnold and Coordinator Deo Thomas.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:
DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023
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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