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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364813234
Report Date: 07/11/2019
Date Signed: 07/11/2019 02:31:25 PM

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:VOLUNTEERS OF AMERICA EARLY HEAD STARTFACILITY NUMBER:
364813234
ADMINISTRATOR:SYLVIA GREENBERGFACILITY TYPE:
830
ADDRESS:720 S. E STREETTELEPHONE:
(909) 888-4577
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92408
CAPACITY:48CENSUS: 26DATE:
07/11/2019
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Gloria Delgado, Interim AdministratorTIME COMPLETED:
02:10 PM
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Licensing Program Analyst's (LPA's), Taadhimeka Ziegler and Carlos Martinez, made a Case Management- Annual Continuation visit on this date to review staff records, and obtain staff signatures. During initial visit conducted, the LPA's computer went into a consistency check and was unable to obtain signatures on all reports.

In addition, Staff records were reviewed this date. During initial visit, the Administrator was not on premises and staff did not have access to files.

There were no deficiencies were cited at this time.

Exit interview was conducted with Ms. Delgado, and a copy was provided. A Notice of Site Visit was issued and must be posted for 30 days.

This report must be made available at the facility for 3 years for public review upon request.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Carlos MartinezTELEPHONE: (951) 782-4936
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2019
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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