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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364813098
Report Date: 09/06/2023
Date Signed: 09/06/2023 01:15:38 PM


Document Has Been Signed on 09/06/2023 01:15 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: 50DATE:
09/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Luz GonzalezTIME COMPLETED:
01:25 PM
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On this date and time, Licensing Program Analyst (LPA) Laura Mejorado arrived at the facility to conduct a Case Management inspection regarding an unusual incident report (UIR) that was submitted to the Department. UIR documented the playground was being renovated. LPA met with Director Luz Gonzalez, toured the facility, and took census.

LPA inspected the renovated playground which included adding push bars and alarms to the doors exiting the playground. Renovations were found to be in compliance with title 22 regulations.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Exit interview conducted and report was reviewed with Director Luz Gonzalez.

SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Laura MejoradoTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2023
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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