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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801214
Report Date: 07/21/2022
Date Signed: 07/21/2022 01:11:13 PM

Document Has Been Signed on 07/21/2022 01:11 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
INLAND EMPIRE CHILD, 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: 168CENSUS: 42DATE:
07/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Wiiliam Alvarez - Site SupervisorTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Rachel Zeron made an unannounced case management visit to follow up on two unusual incident reports that were filed by the facility dated 06/23/22 and 07/14/22. Both incidents involved personal rights issues. LPA arrived at the facility and met with William Alvarez and explained the reason for the visit. LPA toured the facility with Mr. Alvarez and took census.

LPA conducted interviews with staff and will need to return to conduct additional interviews and gather additional information.

LPA conducted an exit interview with the Site Supervisor, William Alvarez. A notice of site visit was given and is required to posted for the next 30 days.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2022
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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