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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425651
Report Date: 01/29/2025
Date Signed: 01/29/2025 08:11:24 AM

Document Has Been Signed on 01/29/2025 08:11 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:EAGEL TIME CARE FACILITYFACILITY NUMBER:
336425651
ADMINISTRATOR/
DIRECTOR:		JUAN CORNELLFACILITY TYPE:
740
ADDRESS:1622 PALERMO DRIVETELEPHONE:
(562) 685-4610
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
01/29/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Juan Cornell, AdministratorTIME VISIT/
INSPECTION COMPLETED:
08:15 AM
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Licensing Program Analyst (LPA) Yolanda Delgado conducted a case management visit to clear deficiencies that were issued on 1/27/2025. There were no issues or concerns observed during the visit. There are five (5) clients that live at the facility with one (1) is at program currently. There are sufficient staff on duty. Deficiencies were cleared and copy was provided.

A copy of this report was reviewed with the Administrator and a copy was provided at the time of the exit interview.
Jazmond D HarrisTELEPHONE: (951) 248-0318
Yolanda DelgadoTELEPHONE: (951) 203-2990
DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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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