<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808742
Report Date: 03/30/2022
Date Signed: 03/30/2022 11:46:11 AM


Document Has Been Signed on 03/30/2022 11:46 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:SBCSS LOS AMIGOS STATE PRESCHOOLFACILITY NUMBER:
364808742
ADMINISTRATOR:NANCY ALAVARADOFACILITY TYPE:
850
ADDRESS:8498 9TH STREETTELEPHONE:
9099464807
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:22CENSUS: 17DATE:
03/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:32 AM
MET WITH:Shonna MoraTIME COMPLETED:
12:03 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 3/30/2022 at 10:32 am, Licensing Program Analyst (LPA) Patricia Berry conducted a case management visit to amend an 809/1 year required visit. LPA was not able to generate missing "C" pages from the amended 809. LPA will need to seek further assistants in the matter.


LPA will return at a later date to complete the report.


Exit interview with Site Supervisor, report, appeal rights and Notice of Site Visit provided.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1