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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844696
Report Date: 12/05/2022
Date Signed: 12/05/2022 03:14:49 PM


Document Has Been Signed on 12/05/2022 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:VOA SOUTHWEST FONTANA EARLY LEARNING CENTERFACILITY NUMBER:
364844696
ADMINISTRATOR:GURTIS, ISABELFACILITY TYPE:
850
ADDRESS:14750 LIVE OAK AVENUETELEPHONE:
(909) 743-6565
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY:225CENSUS: 74DATE:
12/05/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Isabel Gurtis Center Coordinator TIME COMPLETED:
03:15 PM
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On the above noted date and time, a case management visit was conducted in response to the receipt of a self reported unusual incident report (UIR) from the facility. The phoned self reported UIR was received on 11/18/22, date of incident was 11/18/22. A hard copy UIR was received on 11/22/22 . LPA met with the Center Coordinator to review the reported information. Facility records were reviewed and Licensing Program Analyst (LPA) viewed the site footage for the estimated time frame. The following information was obtained:

It was reported to the Center Coordinator by the parent of C1 that the child stated, she was flicked on her head by S1 during nap, no specific date was provided. At time of reported information the Center Coordinator viewed the school classroom footage for room 6 and conducted interviews. S1 denied the allegation and the assisting staff did not see the incident occur. The review of the video footage did not show S1 flicking C1 on the head. LPA observed the footage and did not see the reported incident occur.

Based on information gathered, the facility acted appropriately, and no violations have been identified.

At this time the facility took appropriate action by completing self-reporting requirements as required for Unusual Incidents (UIR):

There are no deficiencies cited.

An exit interview was conducted, Notice of Site Visit issued, and a copy of this report was provided to the Center Coordinator.

A copy of this report must be made available to the public upon request for 3 years.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Diana BraselTELEPHONE: 951-205-9491
LICENSING EVALUATOR SIGNATURE:
DATE: 12/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/05/2022
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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