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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360904126
Report Date: 08/23/2023
Date Signed: 08/23/2023 10:32:35 AM

Document Has Been Signed on 08/23/2023 10:32 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:FAITH LUTHERAN DAY CARE CENTERFACILITY NUMBER:
360904126
ADMINISTRATOR:HEATHER URIBEFACILITY TYPE:
850
ADDRESS:12449 CALIFORNIA STREETTELEPHONE:
(909) 790-1816
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY: 30TOTAL ENROLLED CHILDREN: 25CENSUS: 19DATE:
08/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:Heather UribeTIME COMPLETED:
10:40 AM
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A case management inspection was conducted to follow-up on an Unusual Incident Report (UIR) submitted by the facility on 08/07/2023. Licensing Program Analysts (LPAs) Taityana Benson and Laura Mejorado met with Director, Heather Uribe to discuss the reported incident. LPAs toured the facility, took census, reviewed facility records, and conducted interviews with staff involved in the reported incident.

It was reported that that on August 04, 2023, at 4:15 p.m., a child exhibited symptoms of possible heat exhaustion while on the playground. During interviews, it was stated that staff took immediate action once the child symptoms were observed. The facility immediately assessed the child, called 911, called parents and reported the incident timely. Based on the information obtained, the facility acted appropriately, and no violations of Title 22 Regulations have been identified.

An exit interview was held with Director, Heather Uribe. A Notice of Site visit was issued, along with a copy of this report.

This report shall be public record for three years.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2023
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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