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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846066
Report Date: 05/24/2024
Date Signed: 05/24/2024 02:57:38 PM

Document Has Been Signed on 05/24/2024 02:57 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:PSD/MILL CHILD DEVELOPMENT CENTERFACILITY NUMBER:
364846066
ADMINISTRATOR/
DIRECTOR:		SOARES, CHERYLFACILITY TYPE:
850
ADDRESS:205 SOUTH ALLEN STREETTELEPHONE:
(909) 383-2025
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92408
CAPACITY: 160TOTAL ENROLLED CHILDREN: 160CENSUS: 46DATE:
05/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Cheryl SoaresTIME VISIT/
INSPECTION COMPLETED:
02:40 PM
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On 05/24/2024 Licensing Program Analyst (LPA) Justin Giese made an unannounced visit to the facility to follow-up on the submission of an Unusual Incident Report (UIR). The UIR outlined a potential incident which occurred on 05/22/2024 pertaining to Personal Rights. LPA met with Administrative Supervisor, Cheryl Soares.

LPA toured facility inside/out, took census, reviewed/collected documents and conducted an interview with Staff. Due to insufficient information available currently, further investigation will be necessary. LPA will return to the facility on a later date to conclude the UIR investigation.

An exit interview was conducted, LPA provided Administrative Supervisor, Cheryl Soares with a copy of this report and a notice of site visit on 05/24/2024.

Notice of Site Visit must remain posted for the next 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2024
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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