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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426108
Report Date: 07/14/2022
Date Signed: 07/14/2022 03:05:19 PM

Document Has Been Signed on 07/14/2022 03:05 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:FIRST STEP CORONAFACILITY NUMBER:
336426108
ADMINISTRATOR:QUIROGA, MICHELLEFACILITY TYPE:
775
ADDRESS:237 RIVER RDTELEPHONE:
(951) 371-5593
CITY:CORONASTATE: CAZIP CODE:
92880
CAPACITY: 75CENSUS: 75DATE:
07/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Sophie Ponce, Program SupervisorTIME COMPLETED:
03:15 PM
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Licensing Program Analysts (LPAS) Rayshaun Nickolas and Amy Goldenberg arrived to the facility to deliver amended reports initially delivered to the facility on 12/06/2021 and 03/21/2022. The reports were reviewed with and copies were provided to Sophie Ponce, Program Supervisor.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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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