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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364803883
Report Date: 10/18/2019
Date Signed: 10/18/2019 01:04:19 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:FUSD/SHADOW HILLS ELEMENTARYFACILITY NUMBER:
364803883
ADMINISTRATOR:DARCY WHITNEYFACILITY TYPE:
850
ADDRESS:14300 SHADOW DRIVETELEPHONE:
(909) 357-5750
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY:48CENSUS: DATE:
10/18/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:La Donna Turner TIME COMPLETED:
01:10 PM
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Licensing Program Analysts, Carlos Martinez and Marlene Wong, conducted a case management visit in response to the receipt of an Unusual Incident Report (UIR) from the facility. The UIR was received by the licensing agency on 10/11/19. UIR was sent to CCL in a timely manner. It indicates the mother of a preschool child was in an abusive situation.

Facility records were reviewed and staff was interviewed. Donna Turner, Teacher, said the incident occurred in front of the elementary school. She said the school's principal called Fontana Police Department and there was a police report filed. Ms. Turner said the preschool children did not witness the incident.

Based on information gathered, Analyst has deemed this incident could not have happened and the facility acted appropriately. No violations have been identified.

An exit interview was conducted with Ms. Turner and a copy of this report was left at the facility.

Notice of Site Visit issued and Analyst observed Ms. Turner posted the notice.

SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Marlene WongTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2019
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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