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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843061
Report Date: 01/10/2020
Date Signed: 01/27/2020 04:25:29 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: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: 0DATE:
01/10/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Pauline CopasTIME COMPLETED:
12:00 PM
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This is a digital copy of written report given to licensee on 01/10/2020; Original report has an original signature.
Licensing Program Analyst, Nelson Zuniga attempted to conduct an annual inspection. Due to computer issues, this inspection will be attempted at a later day and time. An exit interview was conducted.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:

DATE: 01/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2020
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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