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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364810041
Report Date: 03/06/2024
Date Signed: 03/06/2024 01:19:43 PM

Document Has Been Signed on 03/06/2024 01:19 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:SBCUSD-WARM SPRINGS PRESCHOOLFACILITY NUMBER:
364810041
ADMINISTRATOR:KELLY, LATASHIAFACILITY TYPE:
850
ADDRESS:7497 STERLING AVENUETELEPHONE:
(909) 338-6500
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92410
CAPACITY: 23TOTAL ENROLLED CHILDREN: 23CENSUS: 15DATE:
03/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Teacher Kulsum RahemtullaTIME COMPLETED:
01:29 PM
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Licensing Program Analyst (LPA) Steven Montoya arrived and Teacher for the purpose of following up on Unusual Incident Report (UIR) investigation at SBCUSD Warm Springs dated 2-23-2024 regarding allegation of child injury and personal rights violation.
LPA disclosed the purpose of the visit and inspection. Present during today’s inspection were 15 children in care and staff. LPA briefly tour of the site and interview relevant witness (C1) and no deficiencies were observed.

Based on relevant witness interviews, observation of playground and review of medical report, the supervision the day care, child sustaining injuries was unsubstantiated. No further action will be taken.

A copy of the inspection report and notice of site visit was provided to the Teacher.


Exit
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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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