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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336409382
Report Date: 05/18/2023
Date Signed: 05/18/2023 02:37:29 PM

Document Has Been Signed on 05/18/2023 02:37 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BASIC OCCUPATIONAL TRAINING CENTER, INC.FACILITY NUMBER:
336409382
ADMINISTRATOR:MITZIE YODITESFACILITY TYPE:
775
ADDRESS:1323 JET WAYTELEPHONE:
(951) 657-8028
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY: 105CENSUS: 75DATE:
05/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Katie Ryker, Director of OperationsTIME COMPLETED:
02:45 PM
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On 5/18/2023, Licensing Program Analyst (LPA), Chinwe Nwogene arrived unannounced at the facility to conduct a case management visit to follow up on the special incident report received on 5/15/2023. LPA met with Director of Operations, Katie Ryker who was informed of the purpose of the visit.

During the visit, LPA Nwogene interviewed staff, interviewed client, review staff file and collected pertinent documents. No citation was issued during today’s visit.

An exit interview was conducted were this report was discussed with and provided to Katie Ryker.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2023
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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