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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364801868
Report Date: 01/25/2024
Date Signed: 01/25/2024 02:33:41 PM

Document Has Been Signed on 01/25/2024 02:33 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:CUCAMONGA STATE PRESCHOOLFACILITY NUMBER:
364801868
ADMINISTRATOR:MONIQUE ESPINOZAFACILITY TYPE:
850
ADDRESS:8677 ARCHIBALD AVENUETELEPHONE:
(909) 980-1318
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 17DATE:
01/25/2024
TYPE OF VISIT:Case Management - Lead Testing/ExceedanceUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Monique Espinoza/lead teacherTIME COMPLETED:
02:50 PM
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On 1/25/24 at 1:05 pm, Licensing Program Analyst (LPA), Patricia Berry conducted a Case Management inspection due to required lead testing requirements based on lead testing results received on the facility for outlet: (G) 20.0. LPA toured the facility, took census and met with Monique Espinoza to further discuss lead results received and measures taken for remediation of lead exceedances.

During the inspection, LPA toured and obtained photos of the following water outlet identified with lead exceedances: Outlet: (G) 20.0, was identified. LPA identified outlet (G) as an outlet in the staff lounge. LPA observed outlet (G) is in an area where the door to the classroom is locked and the children do not have any access into the staff lounge. Nyesha Williams/Director of expanded learning stated the outlet is not ever used and has been turned off.

Due to the outlet not identified as a required outlet to be tested by PIN 21-21-CCP, therefore, there is no violation and the facility was not cited. The Nyesha Williams/Director of expanded learning stated the LIC 9275, LIC 9276, LIC 999 and report will be sent to LPA for documentation.

Exit interview conducted with Monique Espinoza , report, appeal rights and notice of site visit issued.

Notice of site visit must be posted for 30 days.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2024
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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