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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334840476
Report Date: 05/19/2023
Date Signed: 05/19/2023 10:22:16 AM

Document Has Been Signed on 05/19/2023 10:22 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LEUSD ORTEGA PRESCHOOLFACILITY NUMBER:
334840476
ADMINISTRATOR:STEVE BEHARFACILITY TYPE:
850
ADDRESS:520 CHANEY STREETTELEPHONE:
(951) 253-7129
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY: 29TOTAL ENROLLED CHILDREN: 29CENSUS: DATE:
05/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Sarah YatesTIME COMPLETED:
10:35 AM
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On 05/19/2023, Licensing Program Analyst (LPA) Lorena Valenzuela conducted a case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility.

LPA met with Sarah Yates, CFS Supervisor. The UIR was received by the licensing agency on 01/31/2023 and indicates Staff #1 pulled on Child #1’s arm (see Confidential Names List form, LIC 811).



Facility records were reviewed and three staff were interviewed. LPA Valenzuela attempted to interview Child #1 but LPA was not authorized by child’s parent/ authorized representative. Based on information gathered, the facility acted appropriately, and no violations have been identified.

An exit interview was conducted and a copy of this report was provided to Sarah Yates.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2023
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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