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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846061
Report Date: 11/14/2022
Date Signed: 11/14/2022 11:15:03 AM

Document Has Been Signed on 11/14/2022 11:15 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:LA SIERRA ACADEMY CHILDREN'S CENTERFACILITY NUMBER:
334846061
ADMINISTRATOR:ARGUELLO, MARITZAFACILITY TYPE:
850
ADDRESS:4900 GOLDEN AVENUETELEPHONE:
(951) 351-1445
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY: 60TOTAL ENROLLED CHILDREN: 35CENSUS: 23DATE:
11/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maritza Arguello, DirectorTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Kay Turner arrived at the facility on a case management visit to follow-up on an unusual incident report submitted by the facility on 10/20/2022. At the time of visit, LPA toured the facility (specifically were the reported incident took place), took census, and met with Director, Maritza Arguello, to discuss the reported incident. During the visit, LPA also spoke with the Teacher who witnessed the incident as it took place.

Based on the information obtained during the visit, as well as observation of the video, there appeared to be no violations of Title 22 Regulations pertaining to the reported incident.

An exit interview was held with Director, Maritza Arguello. A Notice of Site visit was issued, along with a copy of this report. This report shall be public record for three years.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Karrene Turner
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2022
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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