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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330910640
Report Date: 08/13/2024
Date Signed: 08/13/2024 12:24:40 PM

Document Has Been Signed on 08/13/2024 12:24 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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:EDGEMONT ELEMENTARY HEAD STARTFACILITY NUMBER:
330910640
ADMINISTRATOR/
DIRECTOR:		ADCOCK,JENNIFERFACILITY TYPE:
850
ADDRESS:21790 EUCALYPTUS AVENUETELEPHONE:
(951) 571-4716
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 55TOTAL ENROLLED CHILDREN: 55CENSUS: 0DATE:
08/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:31 AM
MET WITH:Misty Kelley, PrincipalTIME VISIT/
INSPECTION COMPLETED:
10:11 AM
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Licensing Program Analysts (LPA) Jesse Gardner and Licensing Program Manager (LPM) Carlos Martinez conducted a case management inspection, due to the Licensee requesting to replace classroom #102 and begin utilizing classroom #123. The Fire Department granted the fire clearance on 8/7/2024. A tour of the inside and outside of the facility was granted and the following was observed and/or noted: LPA Gardner and LPM Martinez measured Room #123 which is designated as a preschool classroom.

Preschool Indoor Activity Areas

Classroom #123:
Carpeted area: 39 x 26.3 = 1025.7 (Encumbered Space = 27.96)
- 1,025.7 - 27.96 = 997.74 (997.74/35 = 28.5)
Non-Carpeted area: 21.2 x 7.75 = 164.3 (Encumbered Space = 21.05)
- 164.3 - 21.05 = 143.25 (143.25/35 = 4.09)
Capacity (28.5 + 4.09 = 32.59) = 33

Total capacity for preschool classroom #123 = 33 children

Preschool Bathroom Fixtures
2 toilets x 15 = 30 children 3 sinks x 15 = 45 children
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: EDGEMONT ELEMENTARY HEAD START
FACILITY NUMBER: 330910640
VISIT DATE: 08/13/2024
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No deficiencies were cited at the conclusion of the visit. Department staff have determined that there is sufficient space to accommodate the requested 17 children.

An exit interview was conducted, and a copy of this report was reviewed with Principal Misty Kelley along with a copy of the Appeal Rights.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC809 (FAS) - (06/04)
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