364815524-9-20-2023-09-CC-GCAO-CVUNZA-20230920105402

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364815524
Report Date: 09/20/2023
Date Signed: 09/20/2023 10:54:04 AM

Document Has Been Signed on 09/20/2023 10:54 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	FUSD-DOROTHY GRANT ELEMENTARY		FACILITY NUMBER:	364815524
ADMINISTRATOR:	DARCY WHITNEY		FACILITY TYPE:	850
ADDRESS:	7069 ISABEL LANE		TELEPHONE:	(909) 357-5540
CITY:	FONTANA	STATE: CA	ZIP CODE:	92336
CAPACITY: 24	TOTAL ENROLLED CHILDREN: 24	CENSUS: 19	DATE:	09/20/2023
TYPE OF VISIT:	Case Management - Incident	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Eman Metri, Coordinator		TIME COMPLETED:	11:00 AM

NARRATIVE

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A case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 09/11/23. It indicates an alleged inappropriate interaction between two children occurred on 09/08/23 and a CPS report was made. An initial visit was completed on 09/14/23 at which time interviews were conducted.

Facility and agency records were reviewed, written statements obtained, and interviews conducted with pertinent parties. Based on information gathered, the facility acted appropriately, and no violations have been identified. Facility staff conducted interviews with child and parent present; notified CPS and Licensing within the time frame set forth in Title 22 regulations. If additional informational is received incident can be renewed.

An exit interview was conducted, and a copy of this report, appeal rights notice of site visit was provided to facility staff.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

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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