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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801214
Report Date: 04/22/2022
Date Signed: 04/22/2022 01:55:29 PM

Document Has Been Signed on 04/22/2022 01:55 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: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: 72DATE:
04/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Tamara Wagner/Site SupervisorTIME COMPLETED:
02:11 PM
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On 4/22/22 at 1:13 pm, Licensing Program Analyst (LPA) Patricia Berry conducted a case management incident investigation. LPA was granted access into the facility and met with site supervisor. LPA toured facility and took a census. LPA obtained documentation.

It was self- reported on 4/12/22 a teacher slapped a child in the leg during breakfast time. SS stated she did an internal investigation and both teachers who work in the classroom with the child deny the incident occurred.

Due to insufficient information LPA will need to return at a later date to deliver final report.


Exit interview conducted with SS, report appeal rights and Notice of site visit provided to the director.


Notice of site visit must be posted for 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2022
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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