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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334811701
Report Date: 10/24/2024
Date Signed: 10/24/2024 01:59:42 PM

Document Has Been Signed on 10/24/2024 01:59 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: 88CENSUS: 50DATE:
10/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:38 PM
MET WITH:Elizabeth ZaragozaTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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On October 24, 2024, at 12:38 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 10/17/2024 and incident occurred on 10/15/2024. LPA met with Director Elizabeth Zaragoza and advised of the reason for the visit. UIR indicated the wrong child was released from CCC to Child Protective Services (CPS) and was corrected prior to leaving CCC.

During the visit LPA reviewed documents and conducted interviews. LPA also confirmed that training has been provided to staff on release procedures, CPS site visits, communication and documentation. Director also advised that disciplinary action will be taken for staff involved. Based on information gathered, the CCC acted appropriately and no violations of Title 22 have been identified.

An exit interview was conducted with Elizabeth Zaragoza. A copy of this report and appeal rights were issued, along with a Notice of Site visit. This report shall be public record for three years.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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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