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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336424627
Report Date: 10/10/2023
Date Signed: 10/10/2023 01:31:33 PM

Document Has Been Signed on 10/10/2023 01:31 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,
, CA
FACILITY NAME:BASIC OCCUPATIONAL TRAINING CENTERFACILITY NUMBER:
336424627
ADMINISTRATOR:YODITES, MITZIEFACILITY TYPE:
775
ADDRESS:1121 BRADFORD CIRCLETELEPHONE:
(951) 268-3185
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY: 100CENSUS: 50DATE:
10/10/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
12:05 PM
MET WITH:Angela Bello, Case Manager TIME COMPLETED:
01:45 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 an interview with Client #1 (C1) in regards to an open complaint control number 18-AS-20231006155450, that is not related/associated with this facility.

LPA was greeted and granted entry by Case Manager Angela Bello, where LPA explained the purpose of her visit.

No heath and safety concerns were observed at the time of LPAs visit.

An exit interview was conducted, and a copy of this report was reviewed and provided to Angela Bello.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2023
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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