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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334811701
Report Date: 11/20/2024
Date Signed: 11/20/2024 11:08:50 AM

Document Has Been Signed on 11/20/2024 11:08 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 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: 74CENSUS: 64DATE:
11/20/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:23 AM
MET WITH:Elizabeth Zaragoza and Kimberly ByersTIME VISIT/
INSPECTION COMPLETED:
10:28 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 November 20, 2024, at 9:23 am, 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, 10/24/2024. LPA met with Director Elizabeth Zaragoza and Kimberly Byers, Education Coordinator and advised of the reason for the visit. UIR indicated a child dislocated their elbow. The child's hand was being held by another child who was standing behind the injured child as the injured child sat to go down the slide and medical attention was provided.

During the visit LPA reviewed documents and conducted interviews. 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 Elizabeth Zaragoza and Kimberly Byers. 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: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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