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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846079
Report Date: 05/06/2024
Date Signed: 05/06/2024 10:37:01 AM

Document Has Been Signed on 05/06/2024 10:37 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:FORTUNE PRESCHOOLFACILITY NUMBER:
364846079
ADMINISTRATOR/
DIRECTOR:		SAHLAH STORKSFACILITY TYPE:
850
ADDRESS:655 W 2ND STTELEPHONE:
(909) 884-1410
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92410
CAPACITY: 36TOTAL ENROLLED CHILDREN: 36CENSUS: 10DATE:
05/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:SAHLAH STORKSTIME VISIT/
INSPECTION COMPLETED:
10:20 AM
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On 05/06/2024 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 an incident which occurred on 04/30/2024 pertaining to Admission Agreements. LPA met with Director Sahlah Storks.

LPA toured facility inside/out, took census, collected/reviewed documents pertinent to this UIR and conducted interviews with staff present. 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 the Director, Sahlah Storks with a copy of this report and a notice of site visit on 05/06/2024.

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: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2024
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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