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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330910709
Report Date: 03/22/2023
Date Signed: 03/22/2023 02:51:57 PM

Document Has Been Signed on 03/22/2023 02:51 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 SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:CVUSD - PALM VIEW HS CENTERFACILITY NUMBER:
330910709
ADMINISTRATOR:MARCELLA ZAMUDIOFACILITY TYPE:
850
ADDRESS:1390 7TH STREETTELEPHONE:
(760) 848-1644
CITY:COACHELLASTATE: CAZIP CODE:
92236
CAPACITY: 44TOTAL ENROLLED CHILDREN: 19CENSUS: 0DATE:
03/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Andrea TabodaTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Ana Noble and Jeanette Sanchez arrived at the facility on a case management inspection to follow-up on an Unusual Incident Report (UIR) which occurred on March 10, 2023. At the time of inspection, LPA toured the facility, took census, interviewed and met with Francisca Aguirre, Paraeducator, and Ms. Andrea Taboda which is a substitute teacher to discuss the purpose of the visit.

The reported incident took place on March 10, 2023, a child was unresponsive and paramedics were call and transported to hospital.

LPAs interviewed both staff present and obtained records available. LPA will extend the investigation to obtain additional information.

An exit interview was conducted with Andrea Taboda, Sub Teacher. Appeal rights discussed and a copy of this report was provided.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2023
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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