<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360907186
Report Date: 01/04/2022
Date Signed: 01/04/2022 05:15:36 PM

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:SAN ANDREAS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
360907186
ADMINISTRATOR:ANITA REAFACILITY TYPE:
850
ADDRESS:3232 E. PACIFIC AVENUETELEPHONE:
(909) 862-4063
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY:34CENSUS: 13DATE:
01/04/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Lorena Rodriguez-PetersonTIME COMPLETED:
11:35 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 01/04/2022 at 10:00am, Licensing Program Analyst (LPA) Destinee Hogue conducted a case management inspection with Site Supervisor, Lorena Rodriguez-Peterson. 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 12/20/2021.

During this inspection, LPA toured the facility inside and outside, took census of daycare children present on this date, interviewed staff and children, reviewed records, and discussed the following with Site Supervisor.

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

LPA conducted an exit interview with Site Supervisor 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.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1