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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360906598
Report Date: 03/25/2022
Date Signed: 09/22/2022 03:25:54 PM

Document Has Been Signed on 09/22/2022 03:25 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:CJUSD/SAN SALVADOR CHILDREN'S CENTERFACILITY NUMBER:
360906598
ADMINISTRATOR:MACK, MELISSAFACILITY TYPE:
850
ADDRESS:471 AGUA MANSA ROADTELEPHONE:
(909) 876-4154
CITY:COLTONSTATE: CAZIP CODE:
92324
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 0DATE:
03/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:21 PM
MET WITH:Melissa MackTIME COMPLETED:
02:10 PM
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On this date and time, Licensing Program Analyst (LPA) Laura Mejorado conducted a case management inspection with Director, Melissa Mack. A case management inspection 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 03/10/2022. The school was on spring break and no children and staff were present.

During this inspection, LPA reviewed records, and discussed the following with the Director.

At this time, further information will be needed and upon completion of the review, the outcome and/or recommendations will be provided to the Director.

LPA conducted an exit interview with Director and provided a copy of this report. A Notice of Site Visit was issued and must remain posted for the next 30 days.



No deficiencies were cited during this inspection.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2022
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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