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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843061
Report Date: 08/24/2022
Date Signed: 08/24/2022 05:28:40 PM


Document Has Been Signed on 08/24/2022 05:28 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:FOOTHILL CHILD DEVELOPMENT CENTERFACILITY NUMBER:
364843061
ADMINISTRATOR:PAULINE COPASFACILITY TYPE:
840
ADDRESS:791 E. FOOTHILL BLVD. UNIT BTELEPHONE:
(909) 985-4448
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:71CENSUS: 61DATE:
08/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Pauline CopasTIME COMPLETED:
05:35 PM
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Licensing Program Analysts (LPAs) Elyse Jones and Blanca Ruiz arrived at the facility to conduct a case management inspection in response to the receipt of an unusual incident report (UIR) from the facility. At the time of the inspection, LPAs toured the facility, took census, and met with Director, Pauline Copas to further discuss the incident.

Facility records were reviewed, staff and children were interviewed. Further information is needed.

Upon completion of the review, the outcome and/or recommendations will be provided to the licensee.

An exit interview was conducted and a copy of this report was provided to facility.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-SilvaTELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2022
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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