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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364806342
Report Date: 11/15/2022
Date Signed: 11/28/2022 10:35:20 AM

Document Has Been Signed on 11/28/2022 10:35 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:SBCSS MARSHALL STATE PRESCHOOLFACILITY NUMBER:
364806342
ADMINISTRATOR:ROSIO GONZLAEZFACILITY TYPE:
850
ADDRESS:12045 TELEPHONE AVENUE, RM. 33TELEPHONE:
(909) 627-9741
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY: 21TOTAL ENROLLED CHILDREN: 21CENSUS: 13DATE:
11/15/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Hermelinda GonzalezTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA),Rachel Zeron arrived at the facility to follow up on Unusual Incident Report (UIR) that were submitted to Licensing by the facility on 11/01/2022 LPA met with Teacher, Hermelinda Gonzalez to discuss incident.

The reported the following; on October 21,2022, Teacher reported that a child fell while running on the grass holding hands with another child and later parents reported that the child was taken to the hospital to have the injury checked and discovered that the child's arm was fractured.
During interview, it was disclosed that the Teacher observed the incident. Teacher indicated that the child fell while running with another child on the grass. LPA observed the grass area where the child fell, the area was cushioned with grass but also on a slope where the child was hurt. Teacher indicated that she asked the child if she was alright and child said yes and continued to play. A few moments later, child told teacher that their arm was hurting. Child was given an ice pack and parents were called to pick up child.

LPA determined that the facility took the necessary steps to ensure children safety. Based on the information obtained during the visit, there appears to be no violations of Title 22 Regulations pertaining to the reported incident.
An exit interview was conducted, and a copy of this report was provided.

A copy of this report must be made available to the public, at the facility site, for 3 years.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
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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