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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426108
Report Date: 03/30/2023
Date Signed: 03/30/2023 10:36:14 AM

Document Has Been Signed on 03/30/2023 10:36 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
, 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: 55DATE:
03/30/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Day Program Manager Marianne SteadmanTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Amy Goldenberg arrived to the facility unannounced to conduct a Health and Safety visit. During this visit LPA conducted a tour of the Day Program, interacted with clients and staff, and reviewed copies of two records (S1 and C1). This location has electricity and heat. Emergency supplies are in place. Copies of pertinent documentation and photographs were collected.

LPA did not observe any immediate health and safety concerns during the course of this visit.

This report was reviewed with and a copy provided to the facility representative.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE: DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2023
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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