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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364844012
Report Date: 02/19/2025
Date Signed: 02/19/2025 02:21:19 PM

Document Has Been Signed on 02/19/2025 02:21 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: 23CENSUS: 16DATE:
02/19/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Elvia Clavesilla, Center CoordinatorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Taityana Benson arrived at the facility to conclude the case management investigation regarding 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. A previous inspection was conducted on 02/05/2025. LPA was granted entrance into the facility and met with Center Coordinator Elvia Clavesilla. LPA discussed the purpose of the visit and conducted a tour to obtain census.

The UIR received by the licensing agency documented a daycare child sustained an injury to their left arm on 01/24/2025, while in care at the facility. Facility records were reviewed, documentation was obtained, and interviews were conducted with pertinent parties. It was disclosed that on 01/24/2025 while daycare children were on the playground, several staff were present and supervising day-care children when a daycare child sustained an injury to their left arm. It was revealed that a staff member witnessed a day care child jump from play equipment and fall, landing onto the artificial grass. Staff observed the day care child holding their left arm after the fall and staff applied first aid. The LPA inspected the outdoor play equipment which was not damaged and artificial grass is under the play equipment to cushion the day-care child’s fall. The facility followed their operational plan and emergency plan, contacted parents, and provided parents with a written report. Based on information gathered, the facility acted appropriately, and no violations have been identified at this time.

No deficiencies cited 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: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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