364801264-1-24-2025-09-CC-RMOD-DD8UQ8-20250124144642

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364801264
Report Date: 01/24/2025
Date Signed: 01/24/2025 02:46:48 PM

Document Has Been Signed on 01/24/2025 02:46 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	PSD/YUCAIPA HEAD START		FACILITY NUMBER:	364801264
ADMINISTRATOR/ DIRECTOR:	DIANE MILIAN		FACILITY TYPE:	850
ADDRESS:	12236 CALIFORNIA STREET		TELEPHONE:	(909) 797-3585
CITY:	YUCAIPA	STATE: CA	ZIP CODE:	92399
CAPACITY: 66	TOTAL ENROLLED CHILDREN: 66	CENSUS: 0	DATE:	01/24/2025
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:10 PM
MET WITH:	Jazmin Alvarez, Center Clerk		TIME VISIT/ INSPECTION COMPLETED:	02:55 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

On 01/24/2025 at 02:10 PM, Licensing Program Analyst (LPA) Raymond Moorehead arrived at the facility to conduct a case management visit. LPA met with Center Clerk Jazmin Alvarez.

A case management visit was attempted, in response to the receipt of an Unusual Incident Report (UIR) from the facility (self-reported). The UIR was received by the licensing agency on 01/14/2025. The reported incident took place on 01/13/2025.

Upon arrival at the facility, LPA observed no children present in care and 3 staff members present. It was stated that the facility is closed for the children today, due to a staff training/meeting that is conducted monthly. LPA spoke with Director Diane Milian via phone call and informed her of the reason for today's visit. LPA also informed Director that he will return to the facility at a later date, in order to follow with regards to further details on the reported incident.

Therefore, based on information currently available, there were no deficiencies cited at this time.

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.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

An exit interview was conducted, and the report was reviewed with Center Clerk Jazmin Alvarez.

Aaron Ross	TELEPHONE: (951) 782-4200
Raymond Moorehead	TELEPHONE: 951-782-4200
	DATE: 01/24/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 1