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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700600
Report Date: 06/21/2023
Date Signed: 06/30/2023 03:44:43 PM


Document Has Been Signed on 06/30/2023 03:44 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:EES-DAVID & JILLIAN GILMOUR EARLY EDUCATIONFACILITY NUMBER:
376700600
ADMINISTRATOR:KELLY GERTHFACILITY TYPE:
850
ADDRESS:735 AVENIDA DE BENITO JUAREZTELEPHONE:
(760) 639-4170
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY:102CENSUS: 60DATE:
06/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kelly GerthTIME COMPLETED:
10:00 AM
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On June 21, 2023 at 9:15 AM, Licensing Program Analyst (LPA) William Chancellor made an unannounced Case Management visit at EES- David and Jillian Gilmour Early Education to amend an annual report conducted on June 12, 2023. LPA met with Site Director Kelly Gerth to correct the errors in the report regarding dates fire drills were completed and CPR expiration dates. Facility was toured and census was taken.

An exit interview was conducted, signatures were obtained for the amended pages and a copy of this report was provided to the Kelly Gerth. A notice of site visit was also provided and director was reminded the notice must be posted for 30 consecutive days.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: William M Chancellor Jr.TELEPHONE: 951-218-3214
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2023
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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