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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360911439
Report Date: 04/06/2023
Date Signed: 04/06/2023 02:53:56 PM


Document Has Been Signed on 04/06/2023 02:53 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:FUSD/TOKAY ELEMENTARYFACILITY NUMBER:
360911439
ADMINISTRATOR:DARCY WHITNEYFACILITY TYPE:
850
ADDRESS:7846 TOKAY AVENUETELEPHONE:
(909) 357-5770
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY:24CENSUS: 19DATE:
04/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:42 AM
MET WITH:Teacher Violet Jauregui and Assistant Director Maria GarcesTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Samuel Lopez arrived at the facility to conduct a case management visit in response to the receipt of an unusual incident report (UIR). The UIR was received by the licensing agency on 3/17/2023. The UIR documented an incident involving a staff that allegedly pushed a child.

Upon arrival this date on 4/6/2023, LPA Lopez met with Teacher Violet Jauregui and Assistant Director Maria Garces, and stated the purpose of the visit. Records were reviewed and interviews were conducted. The subject child was present and interviewed at the time of the inspection.

Although there were no citations issued today, further information will be needed to continue and conclude the outcome regarding the incident. Upon completion of the review, the outcome and/or recommendations will be provided to the facility representative.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with Teacher Violet Jauregui and Assistant Director Maria Garces.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Samuel LopezTELEPHONE: (951) 897-2482
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2023
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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