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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843931
Report Date: 03/14/2022
Date Signed: 03/14/2022 12:02:07 PM

Document Has Been Signed on 03/14/2022 12:02 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:SHEPHERD OF THE VALLEY SCHOOLFACILITY NUMBER:
334843931
ADMINISTRATOR:WILLIAMSON, LINDAFACILITY TYPE:
840
ADDRESS:11650 PERRIS BLVDTELEPHONE:
(951) 924-3422
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY: 30TOTAL ENROLLED CHILDREN: 20CENSUS: 0DATE:
03/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Linda WilliamsonTIME COMPLETED:
12:10 PM
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On 03/14/22 Licensing Program Analysts (LPAs) Sumayya Habeebulla and Nasha King arrived at the facility for a case management visit for completing the COVID19 survey for closures. LPAs met with the Director Linda Williamson, toured the facility and conducted census. Ms. Williamson gave all the information pertaining to the survey and stated that she has not signed up for the stipends yet. Ms. Williamson will be registering for the stipend soon and will contact LPA Habeebulla if more information is required.

An Exit interview was conducted with Linda Williamson and a notice of site visit was provided.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2022
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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