<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376701308
Report Date: 06/01/2023
Date Signed: 06/01/2023 10:02:52 AM


Document Has Been Signed on 06/01/2023 10:02 AM - 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 STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:MAAC FOOTHILL INFANT CENTERFACILITY NUMBER:
376701308
ADMINISTRATOR:BRIZLET ANGONFACILITY TYPE:
830
ADDRESS:1410 FOOTHILL DRIVETELEPHONE:
(760) 741-0541
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:20CENSUS: 0DATE:
06/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Brizlet Angon, DirectorTIME COMPLETED:
10:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On June 1, 2023 at 9 45 AM, Licensing Program Analyst (LPA) CIndy Hamilton made an unannounced Case Management visit at MAAC Foothill Infant Center to deliver an amended LIC 809 and LIC 809-D for a Case management visit conducted on January 25, 2023 due to a deficiency amendment from Type B to a LIC 9102 Technical Violation. LPA met with Director Brizlet Angon . Facility was toured and census conducted.

An exit interview was conducted, and a copy of this report, amended LIC 809, LIC 809-D and LIC 9102 Technical Violation was provided to the Director. A notice of site visit was also provided and Director reminded notice must be posted for 30 consecutive days.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Cindy HamiltonTELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1