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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364807989
Report Date: 09/14/2022
Date Signed: 09/14/2022 11:20:11 AM


Document Has Been Signed on 09/14/2022 11:20 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:SBCUSD-INGHRAM PRESCHOOLFACILITY NUMBER:
364807989
ADMINISTRATOR:KELLY, LATASHIAFACILITY TYPE:
850
ADDRESS:1695 W. 19TH STREETTELEPHONE:
(909) 880-6633
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92411
CAPACITY:24CENSUS: 10DATE:
09/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Rose Mary Bravo/Anna RodgersTIME COMPLETED:
11:15 AM
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On date and time listed above LPAs Justin Giese and Aman Sharma arrived at the facility and attempted to conduct a required 1-year annual inspection.

LPA Giese was granted access to the facility, however LPA Sharma was not granted access and was asked by Assistant Principal, Anna Rodgers, to leave the premises.

LPAs will return to the facility at a later date to conclude this visit. LPA giese left a copy of this report and notice of site visit with Substitute Permit teacher, Rosemary Bravo.

Notice of site visit was posted in a prominent location and must be displayed for 30 days.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2022
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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