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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801956
Report Date: 05/28/2021
Date Signed: 05/28/2021 02:38:24 PM

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:SBCSS ANNA BORBA I STATE PRESCHOOLFACILITY NUMBER:
364801956
ADMINISTRATOR:JENELYN PEREZFACILITY TYPE:
850
ADDRESS:4980 RIVERSIDE DRIVETELEPHONE:
(909) 464-2695
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY:24CENSUS: 0DATE:
05/28/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Yvonne Mendez and Jenelyn PerezTIME COMPLETED:
11:30 AM
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 Due to COVID-19, Licensing Program Analysts (LPAs) Rachel Zeron and Sharleen Robinson conducted a Licensee initiated Case Management Tele-inspection via Microsoft Teams with Program Supervisor, Yvonne Mendez and Teacher, Jenelyn Perez. The facility has requested a room change, from room #2 to room #1. However, the facility is not requesting a capacity increase, the capacity will remain at 24. Currently there are no children in care, the facility has a tentative date to open on August 6, 2021. Hours of operation are Monday through Friday: from 8:00am to 11:00am and 11:45am to 2:45pm. Jenelyn conducted a walk though of the facility both indoors and outdoors.
Measurements were taken on a previous visit:
Indoor activity area measurements:
Classroom 1: 39.6 x 29.1 = 1152.36
Total indoor activity space: 1152.36 divided by 35 = 33 children
Total children toilets and sinks:
4 toilets x 15 = 60 children
4 sinks x 15 = 60 children
Outdoor activity area measurements:
Total outdoor activity space: 2045.95 divided by 75 = 27 children
PLEASE NOTE: There is a waiver on file for the outside play.

COVID-19 technical assistance provided during the inspection.
An exit interview was conducted. Due to COVID-19, a copy of this report was emailed to the Director. The Director has agreed to sign the report and email the report back to the LPA by the end of the business day. LPA has also requested a "read receipt" to verify that the document has been received by the Director. A Notice of Site Visit was emailed as well, the notice will need to be posted for the next 30 days.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Rachel ZeronTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2021
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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