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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801214
Report Date: 08/04/2023
Date Signed: 08/04/2023 12:47:06 PM


Document Has Been Signed on 08/04/2023 12:47 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, 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:224CENSUS: 23DATE:
08/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:William AlvarezTIME COMPLETED:
01:00 PM
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On 08/04/23@ 9:30 a.m. A case management inspection is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. Licensing Program Analysts(LPAs) Blanca Ruiz and Elyse Jones met with Director, William Alvarez. The center was toured, and a census was taken. Facility records were reviewed, and interviews were conducted with Site Supervisor and pertinent parties. LPAs conducted observation of children involved during the inspection.

Further information is needed. LPAs will be following up on the incident to obtain additional information from witnesses present during the incident but not present during today’s inspection.

Upon completion of the review the outcome and/or recommendations will be provided to the Site Supervisor.

An exit interview was conducted, and a copy of this report was reviewed with Site Supervisor, William Alvarez.

A Notice of Site Visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in immediate civil penalties of $100.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Blanca Ruiz-SilvaTELEPHONE: (951) 233-5594
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2023
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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