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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334812348
Report Date: 01/18/2024
Date Signed: 01/18/2024 01:40:17 PM

Document Has Been Signed on 01/18/2024 01:40 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:RCOE-PERRIS HEAD START STATE PRESCHOOL EARLY HEADFACILITY NUMBER:
334812348
ADMINISTRATOR:LORI WIEDENSOHLERFACILITY TYPE:
830
ADDRESS:148 AVOCADO AVENUETELEPHONE:
(951) 826-7200
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY: 63TOTAL ENROLLED CHILDREN: 63CENSUS: 17DATE:
01/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Lori WiedensohlerTIME COMPLETED:
09:45 AM
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On the above date, Licensing Program Analyst (LPA) Jessica Rubio, arrived to the facility to conduct a visit due to a unusual incident report (UIR) received from the facility. LPA met with Director Lori Wiedensohler regarding the UIR reporting that on 1/8/2023, child (C1) sustained a cut to the bridge of their nose after running in a classroom, falling and hitting their nose on a wooden toy crib. There were two staff (S1 and S2) present in the classroom with four children in total. Both staff witnessed the incident, S1 applied first aid and contacted C1's parent, who picked C1 up and took C1 to the Emergency Room, where glue was applied to C1's cut. C1 returned to the facility the next day. LPA observed the area where C1 fell, the toy crib and interviewed S1. LPA determined the facility acted appropriately and there were no deficiencies cited. An exit interview was conducted with Director. A notice of site visit was also provided and must remain posted for 30 days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Jessica M Rubio
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2024
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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