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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818362
Report Date: 10/13/2022
Date Signed: 01/04/2023 03:07:40 PM

Document Has Been Signed on 01/04/2023 03:07 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:SAN BERNARDINO VALLEY COLLEGE CHILD DEV. CTR.FACILITY NUMBER:
364818362
ADMINISTRATOR:WALLACE JOHNSONFACILITY TYPE:
850
ADDRESS:701 S. MT. VERNON AVENUETELEPHONE:
(909) 384-4440
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92410
CAPACITY: 250TOTAL ENROLLED CHILDREN: 250CENSUS: 55DATE:
10/13/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:21 PM
MET WITH:Sandy KargeTIME COMPLETED:
04:50 PM
NARRATIVE
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On this date and time, Licensing Program Analysts (LPAs) Perla Ordones and Laura Mejorado arrived at the facility to conduct an inspection regarding a separate matter. In the course of the inspection LPAs learned that an incident occurred on 09/14/22 that should have been reported to the Riverside Child Care Regional office. The facility failed to meet the reporting requirements per Title 22 regulations.

See LIC809D for cited deficiency of the California Code of Regulations, Title 22.


Exit interview conducted and report was reviewed with Director Sandy Karge.

A notice of site visit was given and must remain posted for 30 days.

A copy of this report must be made available to the public, at the facility site, for 3 years.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE: DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/13/2022
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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Document Has Been Signed on 01/04/2023 03:07 PM - It Cannot Be Edited


Created By: Laura Mejorado On 10/13/2022 at 04:24 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: SAN BERNARDINO VALLEY COLLEGE CHILD DEV. CTR.
FACILITY NUMBER: 364818362

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/20/2022
Section Cited
CCR
101212(d)

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(d) Upon the occurrence, during the operation of the child care center of any of the events specified in (d)(1) below, a report shall be made to the Department... within the Department's next working day and during its normal business hours. In addition, a written report containing the information specified in (d)(2) below shall be submitted to the Department within seven days following the occurrence of such event. This requirement is not met as evidenced by:
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Director agrees to submit the unusual incident report for the incident that occured on 9/14/22 to CCL within 7 days, or by 10/20/22.
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Based on record review and Directors admission, an unusual incident report for an incident that occured at the facility on 9/14/22 was not reported to CCL, which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Laura Mejorado
LICENSING EVALUATOR SIGNATURE:
DATE: 10/13/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/13/2022


LIC809 (FAS) - (06/04)
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