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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360909152
Report Date: 01/09/2024
Date Signed: 01/09/2024 11:43:59 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 01/09/2024 11:43 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551



FACILITY NAME:CSUSB CHILDREN'S CENTERFACILITY NUMBER:
360909152
ADMINISTRATOR:DEANNA HERNDONFACILITY TYPE:
840
ADDRESS:5500 UNIVERSITY PARKWAYTELEPHONE:
(909) 537-5928
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY:16CENSUS: 0DATE:
01/09/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:CLAFFEY HEATHERTIME COMPLETED:
11:52 AM
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Licensing Program Analyst (LPA) Babatunde Ibitoye met with Assistant Director, Heather Moon today for the purpose of conducting a Required 3 years inspection for school Age component . SA Component is on another building on campus due to spacing (the Yasuda Building in Room# 109). The SA component operates during the summer months only (from June to August). Days and Hours of Operation are Mon - Thurs from 7:00 am to 5:30 pm. Presently the Yasuda Building in Room # 109 is not available, the assistant director is requesting for the school age component to go Inactive.

Exit interview conducted, a copy of this report was reviewed and signed by Asst. Director, Heather Moon.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Babatunde IbitoyeTELEPHONE: 661-568-8179
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024
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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