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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364813098
Report Date: 04/07/2022
Date Signed: 04/07/2022 11:18:25 AM


Document Has Been Signed on 04/07/2022 11:18 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: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:
04/07/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:44 AM
MET WITH:Luz GonzalesTIME COMPLETED:
11:30 AM
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On 04/07/2022 Licensing Program Analysts (LPA) Justin Giese conducted a subsequent 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. LPA met with Site Supervisor, Luz Gonzales to discuss the purpose of the visit.

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.

On, March 15, 2022 LPA made an unannounced visit to the facility and conducted interviews with Facility Staff and children in care. Statements from individuals Interviewed and information obtained during the visit support the information stated in the UIR. Facility staff acted quickly to clothe the child and addressed their observations with the Child's Parent/Guardian. Additionally the facility fulfilled their reporting requirements to Licensing. Based on LPA's observations, interviews and information obtained, there appeared to be no violation of Title 22 Regulations pertaining to the reported incident.

An exit interview was conducted, LPA reviewed this report with Site Supervisor, Luz Gonzales. A copy of this report and notice of site visit were provided. Notice of site visit must be displayed in a prominent location for the next 30 days.
No deficiencies were cited. A copy of this report must be made available for the next three years.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2022
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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