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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 02:20:41 PM

Document Has Been Signed on 02/05/2025 02:20 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 - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:23 AM
MET WITH:Elvia ClavesillaTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On the date and time listed, Licensing Program Analysts (LPAs) Eric Ramos and Taityana Benson arrived at the facility to conduct an inspection regarding a separate matter. During the visit, while LPAs were conducting census, one staff member present, S1, was observed engaging with the day care children and who were not associated to the facility.

Based on observation, this is a violation of Title 22 regulation 101170(e)(2) Criminal Record Clearance.

See LIC809-D for cited deficiency.

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 the Center Coordinator Elvia Clavesilla.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Eric Ramos
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)
Page: 1 of 2
Document Has Been Signed on 02/05/2025 02:20 PM - It Cannot Be Edited


Created By: Eric Ramos On 02/05/2025 at 02:11 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: VOLUNTEERS OF AMERICA EHS CC PP
FACILITY NUMBER: 364844012

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/12/2025
Section Cited
CCR
101170(e)(2)

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(e) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility:
(2) Request a transfer of a criminal record clearance as specified in Section 101170(f)
This requirement is not met as evidenced by:
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Licensee agrees to have S1 associated to the facility and agrees to provide proof to Community Care Licensing (CCL) by the Plan Of Correction (POC) due date of 02/12/2025.
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Based on observation, record review and interviews the facility did not comply with the section cited above as LPAs observed one staff member present engaging with the day care children and who were not associated to the facility, which poses a potential health and safety 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:Ana Noble
LICENSING EVALUATOR NAME:Eric Ramos
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2025


LIC809 (FAS) - (06/04)
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