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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360906559
Report Date: 09/22/2022
Date Signed: 09/22/2022 01:30:05 PM

Document Has Been Signed on 09/22/2022 01:30 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, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:CSUSB CHILDREN'S CENTERFACILITY NUMBER:
360906559
ADMINISTRATOR:DEANNA HERNDONFACILITY TYPE:
850
ADDRESS:5500 UNIVERSITY PARKWAYTELEPHONE:
(909) 537-5928
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY: 40TOTAL ENROLLED CHILDREN: 40CENSUS: 14DATE:
09/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Deanna HerndonTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Maddox met with Deanna Herndon, Director to follow up on an Unusual Incident that occurred on 9/16/2022, the UIR was received within the required time frame. Present in the 4 year old classroom were 14 children and 3 teachers.

Description of incident: On the morning of 9/16/2022, Director received a call from child #1's Mom. Mom stated child #1 informed her of an alleged inappropriate act that occurred the previous day between child #1 and child #2.

During this visit, LPA interviewed Child #1 and Child #2, Director, and the 2 teachers mentioned in the UIR. From interviews, LPA was not able to establish, without a doubt, a violation of Title 22 occurred.

Based on the information gathered and interviews, staff followed their reporting policy and procedure. No citation issued on this date.

An exit interview was conducted, and a copy of this report was provided to head of school along with notice of site visit
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Donna Maddox
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2022
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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