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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334810976
Report Date: 07/13/2023
Date Signed: 07/13/2023 08:09:16 AM

Document Has Been Signed on 07/13/2023 08:09 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:FSA-ALVORD CDCFACILITY NUMBER:
334810976
ADMINISTRATOR:LISETTE PEREZFACILITY TYPE:
850
ADDRESS:8230 WELLS AVE.TELEPHONE:
(951) 637-5587
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY: 120TOTAL ENROLLED CHILDREN: 120CENSUS: 16DATE:
07/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Olivia MartinezTIME COMPLETED:
08:15 AM
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On the date and time listed above, a case management visit was conducted by Licensing Program Analyst (LPA) Giselle Carbullido to deliver an amended report. During today’s visit, LPA toured the facility and census was taken, with 16 children present. LPA met with Olivia Martinez, Lead Teacher to deliver amended report.

Exit interview conducted and a copy of this report, appeal rights and notice of site visit was provided to the Lead Teacher. A copy of this report must be made available to the public for 3 years.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
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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