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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801214
Report Date: 01/10/2023
Date Signed: 01/10/2023 01:16:21 PM

Document Has Been Signed on 01/10/2023 01:16 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:PSD/ONTARIO HEAD STARTFACILITY NUMBER:
364801214
ADMINISTRATOR:WILLIAM ALVAREZFACILITY TYPE:
850
ADDRESS:555 W. MAPLE AVENUETELEPHONE:
(909) 984-4117
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY: 224TOTAL ENROLLED CHILDREN: 224CENSUS: 101DATE:
01/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:William Alvarez-DirectorTIME COMPLETED:
01:30 PM
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On 1/10/23 at 12:15 pm Licensing Program Analysts Claudia Caywood and Patricia Berry conducted a subsequent case management incident investigation regarding two unusual incidence that occurred on 11/10/22 and 11/21/22. LPA Caywood interviewed all pertinent party's. Based on information obtained, there are no violations of Title 22 regulations at this time.

Exit interview conducted with director: report, appeal rights, and notice of site visit provided to director.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2023
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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