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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364820496
Report Date: 07/07/2022
Date Signed: 07/07/2022 03:14:28 PM


Document Has Been Signed on 07/07/2022 03:14 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:GOOD STEWARD DAY CAREFACILITY NUMBER:
364820496
ADMINISTRATOR:HARRIET WEAVERFACILITY TYPE:
850
ADDRESS:9229 UTICA AVENUE STE. 160TELEPHONE:
(909) 948-0016
CITY:RANCHO CUAMONGASTATE: CAZIP CODE:
91730
CAPACITY:75CENSUS: 25DATE:
07/07/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:29 PM
MET WITH:Cheryl West/OwnerTIME COMPLETED:
03:40 PM
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On 7/7/2022 at 2:20 pm, Licensing Program Analyst (LPA) Patricia Berry conducted a case management-incident report. LPA was granted access into the facility and met with the owner. LPA toured facility and took a census.

On 6/24/2022 CCL received a self-reported Unusual Incident Report regarding a child reporting a teacher aggressively laying another child down at nap time. LPA conducted interviews and viewed video footage.



Due to insufficient information at this time further investigation will be needed. LPA will return at a later date to deliver final findings.


Exit interview conducted with owner, report, appeal rights and notice of site visit issued to owner.


Notice of site visit must be posted for 30 days.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022
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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