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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801214
Report Date: 09/13/2022
Date Signed: 09/13/2022 10:32:32 AM

Document Has Been Signed on 09/13/2022 10:32 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:PSD/ONTARIO HEAD STARTFACILITY NUMBER:
364801214
ADMINISTRATOR:CHERIE HUDSONFACILITY TYPE:
850
ADDRESS:555 W. MAPLE AVENUETELEPHONE:
(909) 984-4117
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 205TOTAL ENROLLED CHILDREN: 205CENSUS: 104DATE:
09/13/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:11 AM
MET WITH:William Alvarez/DirectorTIME COMPLETED:
10:57 AM
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On 9/13/2022 at 9:00:00 am, Licensing Program Analyst (LPA) Patricia Berry conducted a case management incident inspection. LPA was granted access into the facility and met with the director. LPA toured the facility and took a census.


On 8/26/22 it was self-reported from director a parent saw marks under her child's arms. Parent stated the marks were not here in the morning at drop-off. LPA conducted interviews.

Due to further investigation needed, LPA will need to return at a later date to deliver final findings.


Exit interview conducted with director, report, appeal rights and Notice of Site Visit issued.

Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2022
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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