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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843562
Report Date: 03/20/2024
Date Signed: 03/20/2024 11:55:26 AM


Document Has Been Signed on 03/20/2024 11:55 AM - 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: 15DATE:
03/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Yvonne BaileyTIME COMPLETED:
12:00 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 03/12/24. It indicates a staff grabbed a child by the wrist.

Facility records were reviewed, and pertinent parties’ interviews were conducted, including four staff and one child. Based on information gathered, the facility acted appropriately, and no violations have been identified. Facility utilized behavior intervention strategies (verbal redirection, increased time for transitions, 1-1 assistance); Facility completed reporting requirements as required by Title 22 regulations for UIRS (Telephone notification to Duty Officer and submission of LIC624). Facility maintained staff to child ratios for supervision and communication with authorized representative.


An exit interview was conducted, and a copy of this report, appeal rights and notice of site visit were provided to facility staff.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024
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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