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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336409381
Report Date: 05/17/2023
Date Signed: 05/17/2023 12:14:05 PM

Document Has Been Signed on 05/17/2023 12:14 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BASIC OCCUPATIONAL TRAINING CENTER SAN JACINTOFACILITY NUMBER:
336409381
ADMINISTRATOR:MITZIE YODITESFACILITY TYPE:
775
ADDRESS:1215 BUENA VISTA, STE F,G & HTELEPHONE:
(951) 487-2725
CITY:SAN JACINTOSTATE: CAZIP CODE:
92583
CAPACITY: 75CENSUS: 57DATE:
05/17/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Dana Garcia, Case Manager TIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Javina George made an unannounced collateral visit to the facility. The purpose of the visit was to conduct interviews with Client #1 ( C1), Client #2 (C2), and Client #3 (C3).

The interviews are for a matter not related to this facility. LPA was greeted and granted entry by Dana Garcia, Case Manager, where LPA explained the purpose of the visit.

There were no heath and safety concerns were observed during today's visit.

An exit interview was conducted and a copy of this report was provided to Dana Garcia, Case Manager.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2023
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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