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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330920921
Report Date: 06/05/2024
Date Signed: 06/05/2024 09:52:02 AM

Document Has Been Signed on 06/05/2024 09:52 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:RCOE - ARLANZA HEAD STARTFACILITY NUMBER:
330920921
ADMINISTRATOR/
DIRECTOR:		MONICA PARGAFACILITY TYPE:
850
ADDRESS:5891 RUTLAND AVENUETELEPHONE:
(951) 352-7984
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 23DATE:
06/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Yvonne BaileyTIME VISIT/
INSPECTION COMPLETED:
09:55 AM
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A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 05/28/24. It indicates a staff bumped a child resulting in the child falling.
Facility records were reviewed, and pertinent party interviews were conducted, including four staff and one child. Based on information gathered, the facility acted appropriately, and no violations have been identified. Facility reported to their management department as required for all facility related matters. Facility also completed reporting requirements to the following agencies: CDSS- Licensing; Riverside Police; CPS and submitted an Unusual Incident Report (UIR) as required per Title 22 regulations for UIR.
An exit interview was conducted, and a copy of this report, appeal rights and notice of site visit were provided to facility representative, Yvonne Bailey.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
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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