<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336424627
Report Date: 12/15/2021
Date Signed: 12/15/2021 11:36:55 AM

Document Has Been Signed on 12/15/2021 11:36 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BASIC OCCUPATIONAL TRAINING CENTERFACILITY NUMBER:
336424627
ADMINISTRATOR:YODITES, MITZIEFACILITY TYPE:
775
ADDRESS:1121 BRADFORD CIRCLETELEPHONE:
(951) 735-5084
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY: 100CENSUS: 40DATE:
12/15/2021
TYPE OF VISIT:CollateralANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Karlene DunnTIME COMPLETED:
11:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Stephanie Williams conducted an announced collateral visit to the facility in order to interview staff and clients, collect records, and make observations pertaining to Complaint Control #18-AS-20211210101511. LPA Williams identified herself to Case Manager, Karlene Dunn, who was also informed of the purpose of the visit.

LPA Williams interviewed Client #1 (C1), Staff #1 (S1), and Staff #2 (S2). LPA Williams also collected records from the facility and made observations of C1's lunch.

An exit interview was conducted where this report was discussed and a copy was provided to Dunn at the conclusion of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Stephanie Williams
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1