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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334807098
Report Date: 09/27/2023
Date Signed: 09/27/2023 11:57:47 AM

Document Has Been Signed on 09/27/2023 11:57 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 SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:DSUSD/JACKSON ECE CENTERFACILITY NUMBER:
334807098
ADMINISTRATOR:JAY RALLIONFACILITY TYPE:
850
ADDRESS:82-850 KENNER STREETTELEPHONE:
(760) 238-9904
CITY:INDIOSTATE: CAZIP CODE:
92201
CAPACITY: 47TOTAL ENROLLED CHILDREN: 43CENSUS: 29DATE:
09/27/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Sonia OsorioTIME COMPLETED:
10:00 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 the date and time listed above, Licensing Program Analyst (LPA) Jeanette Sanchez arrived at the facility to to conduct a case management visit regarding an Unusual Incident Report (UIR) received on 9/22/23.

LPA obtained roster and conducted interviews. Further information will be needed. Upon completion of the review, the outcome and/or recommendations will be provided.

Exit interview conducted and report was reviewed with the facility representative Sonia Osorio. A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jeanette Sanchez
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2023
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