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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844722
Report Date: 10/10/2023
Date Signed: 10/10/2023 11:26:09 AM


Document Has Been Signed on 10/10/2023 11:26 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 STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:VALLE VISTA ANNEX PRESCHOOLFACILITY NUMBER:
334844722
ADMINISTRATOR:MELINA SERNAFACILITY TYPE:
850
ADDRESS:26205 FAIRVIEW AVE.TELEPHONE:
(951) 765-1648
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:116CENSUS: 0DATE:
10/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:Christina JironTIME COMPLETED:
11:41 AM
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On October 10, 2023, at 10:47 AM, Licensing Program Analyst (LPA) Anastasia Flores, arrived and was granted access to the facility by Teacher, Christine Jiron. LPA informed Ms. Jiron, the purpose of the visit was for an incident report filed in our office on 9/13/23. LPA toured the playground and area of incident and conducted interviews with two staff members. Child in question is no longer at this facility in elementary school this year.

LPA discussed the safety of the playground and did not see any current safety concerns on the playground. LPA was informed that the wood chips on the playground were filled, and the current Administrator continues to make sure the facility is well maintained.

An exit interview, a copy of report and appeal rights were handed to teacher Christina Jiron.

A notice of site visit was given and must remain posted for 30 days.

SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Anastasia FloresTELEPHONE: (951) 533-2031
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2023
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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