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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844012
Report Date: 02/05/2025
Date Signed: 02/05/2025 01:50:20 PM

Document Has Been Signed on 02/05/2025 01:50 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:VOLUNTEERS OF AMERICA EHS CC PPFACILITY NUMBER:
364844012
ADMINISTRATOR/
DIRECTOR:		ELVIA CLAVESILLAFACILITY TYPE:
850
ADDRESS:799 EAST RIALTO AVENUETELEPHONE:
(909) 332-6690
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92408
CAPACITY: 24TOTAL ENROLLED CHILDREN: 24CENSUS: 18DATE:
02/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:23 AM
MET WITH:Elvia Clavesilla, Center CoordinatorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Taityana Benson and Eric Ramos conducted an unannounced visit to the facility for the purpose of following up on the submission of an Unusual Incident Report (UIR) that was submitted by the facility. The UIR was received by the licensing agency on 01/27/2025. The UIR documented an incident involving a day-care child. LPAs were granted entrance into the facility and met with Center Coordinator, Elvia Clavesilla to discuss the purpose of the visit and conducted a tour to obtain census.

Facility records were reviewed, documentation was obtained, and interviews were conducted. However, LPAs were unable to conduct interviews with additional pertinent parties at the time of the visit. Further information will be needed. Upon completion of the review, the outcome and/or recommendations will be provided to Center Coordinator, Elvia Clavesilla.

No deficiencies cited under Title 22 Regulations for this report, at this time.


A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.



Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Center Coordinator, Elvia Clavesilla.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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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