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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334803230
Report Date: 04/18/2024
Date Signed: 04/18/2024 10:59:48 AM

Document Has Been Signed on 04/18/2024 10:59 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:RCOE - GARRETSON HEAD STARTFACILITY NUMBER:
334803230
ADMINISTRATOR/
DIRECTOR:		KENDRA HAWTHORNEFACILITY TYPE:
850
ADDRESS:1650 GARRETSON AVENUE, ROOM 6TELEPHONE:
(951) 279-4231
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY: 34TOTAL ENROLLED CHILDREN: 34CENSUS: 30DATE:
04/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:58 AM
MET WITH:Cynthia Berumen, Site ManagerTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Elyse Jones arrived at the facility to conduct a Case Management-Incident inspection for the purpose of investigation on an Unusual Incident Report stating a child was sick. At the time of the inspection, LPA toured the facility, took census, and documentation was collected.

Based on information gathered, the facility acted appropriately and no violations have been identified at this time. The facility conducted a health check, contacted the Authorized Representative immediately, and the incident was reported to Licensing in a timely manner.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Cynthia Berumen, Site Manager.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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