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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846066
Report Date: 12/28/2022
Date Signed: 01/03/2023 09:26:19 AM

Document Has Been Signed on 01/03/2023 09:26 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:PSD/MILL CHILD DEVELOPMENT CENTERFACILITY NUMBER:
364846066
ADMINISTRATOR:SOARES, CHERYLFACILITY TYPE:
850
ADDRESS:205 SOUTH ALLEN STREETTELEPHONE:
(909) 383-2025
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92408
CAPACITY: 160TOTAL ENROLLED CHILDREN: 160CENSUS: 54DATE:
12/28/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Cheryl SoaresTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Laura Mejorado arrived at the facility to conduct a case management visit in response to the receipt of an unusual incident report (UIR). The UIR was received by the Riverside Child Care Regional office. The UIR documented an incident where a child fell off their bike and sustained an Injured arm which require medical attention.

Upon arrival, LPA met with Director Cheryl Soares and stated the purpose of the visit. LPA toured the facility, inspected the area where the incident occurred and reviewed records. The subject child and staff who may have knowledge of the incident were not present during todays inspection.

More time is needed to complete the investigation.

Exit interview conducted and report was reviewed with Director Cheryl Soares.

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: 12/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2022
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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