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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818364
Report Date: 04/23/2021
Date Signed: 04/23/2021 01:10:14 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:SAN BERNARDINO VALLEY COLLEGE CHILD DEV. CTR.FACILITY NUMBER:
364818364
ADMINISTRATOR:MARK MERJILFACILITY TYPE:
830
ADDRESS:701 S. MT. VERNON AVENUETELEPHONE:
(909) 384-4440
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92410
CAPACITY:60CENSUS: 12DATE:
04/23/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Sandy KargeTIME COMPLETED:
01:15 PM
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An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Justin Giese regarding an Immediate Exclusion Order for Mark Merjil (Merjil). LPA Giese met with Interim Facility Director, Sandy Karge (Interim Director).

During the inspection, LPA Giese explained the details of the Immediate Exclusion Order. Interim Director stated Merjil has not been at the facility since 01/21/2021 and how they understood the Immediate Exclusion Order.

In addition to the Immediate Exclusion Order for the facility, Interim Director was provided a copy of the Order of Individual of Immediate Exclusion from all facilities for Merjil.

An exit interview was conducted, and a copy of this report was provided to the Interim Director on this date. LPA provided the Notice of Site (LIC 9213) form and verified the form was posted prior to concluding the inspection.

A copy of this report must be made available to the public, at the facility site, for three (3) years.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021
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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