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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843054
Report Date: 09/15/2022
Date Signed: 09/15/2022 04:34:56 PM

Document Has Been Signed on 09/15/2022 04:34 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:RENU HOPE FOUNDATIONFACILITY NUMBER:
334843054
ADMINISTRATOR:TIFFANIE ROMANFACILITY TYPE:
850
ADDRESS:21091 RIDER STREETTELEPHONE:
(951) 940-7600
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY: 72TOTAL ENROLLED CHILDREN: 72CENSUS: 22DATE:
09/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:25 PM
MET WITH:Tiffanie Roman TIME COMPLETED:
03:31 PM
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On September 15, 2022 at 2:33 PM, Licensing Program Analyst (LPA) Anastasia Flores arrived and was greeted and granted access to facility by, Site Supervisor, Tiffany Roman. 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 08/01/22. It indicates the child #1 was injured on site resulting in a broken foot. See Confidential names, (LIC811).

Unusual incident was reviewed, and interview was conducted with staff #1. Based on information gathered, the facility acted appropriately, and no violations have been identified. Facility immediately called parent and parent came to pick up child immediately, the incident was reported in a timely manner.

An exit interview was conducted, and a copy of this report was provided to facility staff.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Anastasia Flores
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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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