<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334830641
Report Date: 09/17/2021
Date Signed: 09/17/2021 12:03:39 PM

Document Has Been Signed on 09/17/2021 12:03 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:KIDD STREET PRESCHOOL OF RIVERSIDEFACILITY NUMBER:
334830641
ADMINISTRATOR:MELISSA HAWTHORNEFACILITY TYPE:
830
ADDRESS:10250 KIDD STREETTELEPHONE:
(951) 688-4242
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY: 28TOTAL ENROLLED CHILDREN: 28CENSUS: 14DATE:
09/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maria Teel-Current DirectorTIME COMPLETED:
11:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 9/17/2021 at 10:00 AM, Licensing Program Analyst (LPA) Andrea Taylor conducted an inspection visit with New Director, Maria Teel. (Director's paperwork has been submitted).

A case management inspection is being conducted in response to the receipt of a self reported unusual
incident report (UIR) from the facility. The UIR was received by the licensing agency on 9/10/21.
The incident occurred on 9/09/21.

LPA obtained children's records, staff records, a current children's roster and discussed incident with the Director and the Assistant Director.

LPA will continue to investigate the incident. LPA will make a return visit to inform the Director of the outcome.

No deficiencies were cited today.

An exit interview was conducted.
The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days.
Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent
to the door.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Andrea Taylor
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1