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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843572
Report Date: 03/12/2024
Date Signed: 03/12/2024 03:32:15 PM

Document Has Been Signed on 03/12/2024 03:32 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:ORTEGA TRAIL YOUTH CENTERS, INCFACILITY NUMBER:
334843572
ADMINISTRATOR:KATHY EVERHARTFACILITY TYPE:
840
ADDRESS:23151 PALOMAR STREETTELEPHONE:
(951) 678-5240
CITY:WILDOMARSTATE: CAZIP CODE:
92595
CAPACITY: 30TOTAL ENROLLED CHILDREN: 30CENSUS: 16DATE:
03/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Katherine EverhartTIME COMPLETED:
03:45 PM
NARRATIVE
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On March 12, 2024 at 3:00 PM, Licensing Program Analyst (LPA), Cindy Hamilton, made an unannounced Case Management visit to deliver an amended LIC 809D for Case Management visit conducted on 03/06/24. LPA met with Licensee/Director Katherine Everhart , who was informed of the reason for the premise visit. LPA made corrections to the LIC 809-D dated 03/06/2024. In addition, the correct time of the original report dated March 6, 2024 should be 4:35 PM to 5:15 PM

An exit interview was conducted, and a copy of this report , appeal rights and Notice of Site Visit was provided to the Licensee/Director.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Cindy Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2024
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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