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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334811701
Report Date: 02/26/2025
Date Signed: 02/26/2025 02:28:08 PM

Document Has Been Signed on 02/26/2025 02:28 PM - 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:SJUSD-HYATT HEAD START STATE PRESCHOOLFACILITY NUMBER:
334811701
ADMINISTRATOR/
DIRECTOR:
ZARAGOZA, ELIZABETHFACILITY TYPE:
850
ADDRESS:400 E. SHAVERTELEPHONE:
(951) 487-0526
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY: 108TOTAL ENROLLED CHILDREN: 75CENSUS: 49DATE:
02/26/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Kimberly ByersTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
NARRATIVE
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On February 26, 2025, at 1:10 pm, Licensing Program Analyst (LPA) Cindy Hamilton arrived at SJUSD-Hyatt Head Start State Preschool (CCC) to conduct a case management visit. 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 same day as incident, 02/05/2025. LPA met with Kimberly Byers, Education Coordinator and advised of the reason for the visit. UIR indicated on 02/05/2025, at approximately 10:00 am, a child's elbow was injured. The children were in the classroom, at circle time and the injured child was sitting on the floor, leaning back with arms behind them and another child came and jumped on the child that was sitting down injuring the child's right elbow. The school nurse responded, parent was called and 911 was called. The child and parent were taken to the hospital via ambulance. The facility was later advised the child's right arm was sprained and child returned to school February 7, 2025 with no restrictions. Teacher witnessed incident and completed and submitted UIR.

During the visit LPA reviewed documents and conducted interview. LPA confirmed CCC was in compliance with supervision, ratio, and response at time of the incident. In addition, based on information gathered, the CCC acted appropriately and no violations of Title 22 have been identified.

An exit interview was conducted with Kimberly Byers. A copy of this report, appeal rights, and Notice of Site visit were reviewed and provided to Kimberly Byers. This report shall be public record for three years and Mrs. Byers was reminded that the notice of site visit must remain posted for 30 days.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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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