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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808202
Report Date: 01/19/2021
Date Signed: 01/19/2021 04:37:09 PM

Document Has Been Signed on 01/19/2021 04:37 PM - 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:WATER OF LIFE PRESCHOOLFACILITY NUMBER:
364808202
ADMINISTRATOR:LESLIE NORMANFACILITY TYPE:
850
ADDRESS:7625 EAST AVENUETELEPHONE:
(909) 463-3915
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY: 149TOTAL ENROLLED CHILDREN: 0CENSUS: 36DATE:
01/19/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Leslie Norman Director / Gloria Cesena Assistant Director TIME COMPLETED:
04:30 PM
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On 01/19/2021 at 3:25pm. Licensing Program Analyst (LPA) Diana Brasel placed a telephone call the facility. LPA asked to speak to the Director Leslie Norman, staff stated, she was unavailable. The staff took LPA's number down and stated, they would have her call right back. LPA received a return call from the director at 3:35 pm, the director advised LPA that she is covering another site currently. LPA and the director went through the exemption denial reasons. The assistant director Gloria Cesena contacted LPA at 3:45 pm. LPA conducted an unannounced case management tele-visit via face-time, due to COVID-19 and social distancing. The purpose of the visit is to follow up on a Exemption Denial Confirmation for Michael Burke, which was issued on 01/12/2021. A tour of facility was conducted and a census was taken.

It was confirmed that Michael Burke is not an employee or working at the Child Care Center school site.

Based on evidence obtained during todays' tele-visit, the LPA has verified the individual is not present, employed or residing in the facility.

Verification of removal is complete.

This report will be sent via email to the provided email address with an attached read receipt. A copy of the LIC 9213 will be sent via email along with the report. The read receipt will be used in lieu of the signature on the report. LIC 9213 must be posted at the facility for 30 days.


All reports shall be maintained for three years.
Gilbert Sena
Diana Brasel
DATE: 01/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2021
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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