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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364804311
Report Date: 03/19/2024
Date Signed: 03/19/2024 10:27:12 AM


Document Has Been Signed on 03/19/2024 10:27 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:PSD/UPLAND HEAD STARTFACILITY NUMBER:
364804311
ADMINISTRATOR:MARNIE REILLYFACILITY TYPE:
850
ADDRESS:732 N. 3RD AVENUETELEPHONE:
(909) 931-0147
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:65CENSUS: 25DATE:
03/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Rosa Martinez/lead teacherTIME COMPLETED:
10:55 AM
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On 3/19/24 at 8:30 am, Licensing Program Analyst (LPA) conducted a case management-other to deliver an amended report from 2/20/24. On 2/20/24 LPA issued a type B citation due to the facility not complying with PIN 21-21 CCP for lead testing by 1/23. After LPA's visit, the administrator Julia Chukumerije informed LPA a lead testing was started 4/19/22. The report has been amended and the B citation removed.



Exit interview conducted with lead teacher, report, appeal rights and notice of site visit issued.



Notice of site visit must be posted for 30 days.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2024
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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