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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818441
Report Date: 12/08/2025
Date Signed: 12/08/2025 10:46:42 AM

Document Has Been Signed on 12/08/2025 10:46 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:PSD/FONTANA CITRUS HEAD STARTFACILITY NUMBER:
364818441
ADMINISTRATOR/
DIRECTOR:		ALONDRA LADISONFACILITY TYPE:
850
ADDRESS:9315 CITRUS AVENUETELEPHONE:
(909) 428-8496
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY: 140TOTAL ENROLLED CHILDREN: 140CENSUS: 41DATE:
12/08/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Alondra LadisonTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On date and time listed above, Licensing Program Analyst (LPA), Giselle Carbullido conducted a Case Management inspection based on new lead results from testing conducted on 11/01/25 and 11/05/25 resulting in exceedance for outlet D (7.7ppb); outlet H (5.1 ppb); outlet L (9.1ppb); and outlet M (12 ppb). LPA Carbullido toured the facility to verify if remediation efforts are in progress. LPA took census, and met with facility representative, Alondra Ladison to discuss lead testing results and remediation efforts.

During the inspection, LPA toured and obtained photos of the following water outlets identified with lead exceedance: Outlets D and M located in hallway and Outlets H and L located in bathrooms and not used for drinking or food preparation. As of this date per facility representative, all 4 outlets with exceedance are in the flushing stage required for retesting. LPA observed all 4 outlets are inaccessible and not in use. Additionally, LPA observed bottled water service from vendor- Sparklets used for Primo water dispensers and portable classroom sinks.

Due to facility water outlets D, H, L and M testing above lead action level of 5ppb, the following PIN 21-21.1-CCP was reviewed which includes information on: preparing and conducting lead testing including notification to the department and instructions for remediation. LPA informed facility representative that facility will notify the department within 30 days of new remediation efforts. See LIC9102TV technical advisory.
An exit interview was conducted, and appeal rights discussed. LPA Carbullido informed facility representative that an additional visit may be needed to verify continued remediation efforts. LPA Carbullido provided facility representative, Alondra Ladison with a copy of this report, appeal rights and notice of site visit. This report must be made available to the public upon request for three years.
NAME OF LICENSING PROGRAM MANAGER: Gilbert Sena
NAME OF LICENSING PROGRAM ANALYST: Giselle Carbullido
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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