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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376700797
Report Date: 07/09/2019
Date Signed: 07/09/2019 01:58:15 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MISSION HILLS CHURCH PRESCHOOLFACILITY NUMBER:
376700797
ADMINISTRATOR:WINKLER, ANGELAFACILITY TYPE:
850
ADDRESS:400 MISSION HILLS COURTTELEPHONE:
(760) 759-2164
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY:100CENSUS: 38DATE:
07/09/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Director, Louisa AguilarTIME COMPLETED:
02:15 PM
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A case management visit is being conducted by Licensing Program Analysts (LPAs) James Wilkerson and Susan Brewer arrived the facility on the above date and time, in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 06/13/2019.

Further information will be needed due to specific staff not on schedule at the time of the visit. The child reported to be injured is not present and available to interview. Upon completion of the review, the outcome and/or recommendations will be provided to the Site Director Louisa Aguilar.

An exit interview was conducted and a copy of this report was provided to facility staff.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2019
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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