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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843562
Report Date: 03/15/2024
Date Signed: 03/15/2024 03:57:02 PM


Document Has Been Signed on 03/15/2024 03:57 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:HEATHER ARNOLDFACILITY TYPE:
850
ADDRESS:7711 CASA BLANCA STREETTELEPHONE:
(951) 826-7275
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:47CENSUS: 4DATE:
03/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Yvonne BaileyTIME COMPLETED:
04:00 PM
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A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 03/13/24 with initial phone notification to the department on 03/12/24.

Facility records were reviewed and staff interviews were conducted. Further information will be needed. Upon completion of the review, the outcome and/or recommendations will be provided to the facility representative.

An exit interview was conducted and a copy of this report and appeal rights were provided to facility representative, Yvonne Bailey.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2024
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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