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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364813098
Report Date: 03/15/2022
Date Signed: 03/15/2022 01:00:28 PM


Document Has Been Signed on 03/15/2022 01:00 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:PSD-RIALTO EUCALYPTUS HEAD STARTFACILITY NUMBER:
364813098
ADMINISTRATOR:LUZ GONZALEZFACILITY TYPE:
850
ADDRESS:485 N. EUCALYPTUS AVENUETELEPHONE:
(909) 421-7180
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:120CENSUS: DATE:
03/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Luz GonzalesTIME COMPLETED:
01:15 PM
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On 03/15/2022 Licensing Program Analysts (LPA) Justin Giese conducted an unannounced visit to the facility to follow up on the submission of an Unusual Incident Report (UIR) that was received by the Regional Office on 02/22/2022 and recorded on 03/07/2022. LPA met with Site Supervisor, Luz Gonzales to discuss the purpose of the visit. LPA took census, reviewed records, toured the facility and conducted interviews with staff and children involved.

Facility staff self-reported an incident that occurred at the facility on 02/22/2022. UIR stated that around 12:00 pm, a Child was playing inside the “cozy box” located within the classroom. The Child was observed throwing toys and other items out of the box. Facility staff approached to redirect the Child from throwing items and noticed the child had removed their clothing from the waist down. UIR stated Staff immediately assisted the Child in putting their missing articles of clothing back on.

Due to insufficient information available currently, LPA will return to the facility on a later date to conclude the investigation into this incident.

An exit interview was conducted, LPA Giese provided Site Supervisor with a copy of this report and a notice of site visit on 03/15/2022.

Notice of site visit must be displayed for the next 30 days.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/15/2022
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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