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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801264
Report Date: 01/30/2025
Date Signed: 01/30/2025 11:53:31 AM

Document Has Been Signed on 01/30/2025 11:53 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:PSD/YUCAIPA HEAD STARTFACILITY NUMBER:
364801264
ADMINISTRATOR/
DIRECTOR:		DIANE MILIANFACILITY TYPE:
850
ADDRESS:12236 CALIFORNIA STREETTELEPHONE:
(909) 797-3585
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY: 66TOTAL ENROLLED CHILDREN: 66CENSUS: 22DATE:
01/30/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Diane Milian, Site SupervisorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 01/30/2025 at 10:45 AM, Licensing Program Analyst (LPA) Raymond Moorehead arrived at the facility to conduct a case management visit. LPA met with Site Supervisor Diane Milian and a tour/census was taken.

A case management visit was conducted, 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.

During today's visit, LPA obtained documentation and conducted several pertinent interviews with staff members.

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.

LPA conducted an exit interview with Site Supervisor Diane Milian and provided a copy of this report.
Aaron RossTELEPHONE: (951) 782-4200
Raymond MooreheadTELEPHONE: 951-782-4200
DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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