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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364806734
Report Date: 04/29/2024
Date Signed: 04/29/2024 04:34:11 PM

Document Has Been Signed on 04/29/2024 04:34 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:YMCA/ARROYO VERDE SCHOOL AGE SITEFACILITY NUMBER:
364806734
ADMINISTRATOR/
DIRECTOR:		WHITE, BRENDAFACILITY TYPE:
840
ADDRESS:7701 CHURCH STREETTELEPHONE:
(909) 735-2609
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 19DATE:
04/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:25 PM
MET WITH:Carol HartwickTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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On 04/29/2024 Licensing Program Analyst (LPA) Justin Giese made a subsequent unannounced visit to the facility to follow-up on the submission of an Unusual Incident Report (UIR) that was received by the regional Office on March 15th. The UIR outlined an incident which occurred on 03/08/2024 pertaining to personal rights of a child in care. LPA met with Interim Director Carol Hartwick.

LPA toured facility inside/out, took census, reviewed records and conducted interviews with children present. Due to insufficient information available currently, further investigation will be necessary. LPA will return to the facility on a later date to conclude the UIR investigation.

An exit interview was conducted, LPA provided the Interim Director, Carol Hartwick with a copy of this report and a notice of site visit on 04/29/2024.

Notice of Site Visit must remain posted for the next 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2024
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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