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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808742
Report Date: 03/08/2022
Date Signed: 03/08/2022 02:17:33 PM


Document Has Been Signed on 03/08/2022 02:17 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:SBCSS LOS AMIGOS STATE PRESCHOOLFACILITY NUMBER:
364808742
ADMINISTRATOR:NANCY ALAVARADOFACILITY TYPE:
850
ADDRESS:8498 9TH STREETTELEPHONE:
(909) 946-4807
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:22CENSUS: 17DATE:
03/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Shonna MoraTIME COMPLETED:
02:40 PM
NARRATIVE
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On 3/8/22 at 12:00 pm, an annual inspection is being conducted as part of a compliance review. Licensing Program Analyst (LPA), Patricia Berry, toured the center, inside and out. The following was observed:
· A review of the staff records and review of a sampling of children's records were conducted as part of this evaluation. See Confidential Names List LIC 859 and 857
· The licensee is asked to update the following documents, if applicable, and submit to licensing within 30 days:
1. LIC 500 Personnel Report
2. LIC 610 Emergency & Disaster Plan
3. Parent Handbook/ Program Curriculum/Admission policies and procedures/ fee schedule (only if changes have been made)
4. LIC 309 Administrative Organization (only if changes have been made)
5. LIC 308 Designation of Administrative Responsibility (only if changes have been made)
· The following items have been posted and are updated where necessary:
- License
- Emergency Disaster Plan (LIC610) and Earthquake Preparedness Checklist (LIC9148)
- Parent’s Rights Poster (PUB393)
- Personal Rights (LIC613A)
- Child Car Seat Law
- Menu
· The facility is operating within the terms of the license
· Ratios were met during this inspection
(Cont on 809C)
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022
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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