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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336424627
Report Date: 02/29/2024
Date Signed: 02/29/2024 09:50:46 AM

Document Has Been Signed on 02/29/2024 09:50 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
SAN BERNARDINO ASC, 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) 268-3185
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY: 100CENSUS: 47DATE:
02/29/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Angela Bello, Case Manager TIME COMPLETED:
10:12 AM
NARRATIVE
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Licensing Program Analyst (LPA) Sara Martinez made an unannounced collateral visit to the facility. The purpose of the visit was to conduct an interview with Client One (C1) in regards to a complaint 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: Rikesha Stamps
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/29/2024
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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