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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360900248
Report Date: 03/07/2023
Date Signed: 03/07/2023 03:06:21 PM

Document Has Been Signed on 03/07/2023 03:06 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:PSD/CUCAMONGA HEAD STARTFACILITY NUMBER:
360900248
ADMINISTRATOR:ANITA DELATORREFACILITY TYPE:
850
ADDRESS:9324 SAN BERNARDINO ROADTELEPHONE:
(909) 948-6979
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY: 73TOTAL ENROLLED CHILDREN: 73CENSUS: 31DATE:
03/07/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:36 PM
MET WITH:Malika Binns/Site SupervisorTIME COMPLETED:
03:30 PM
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On 3/7/23 at 1:35 pm, Licensing Program Analyst (LPA) Patricia Berry conducted a subsequent case management incident investigation to interview children in the p.m. class.


Due to additional information needed, LPA will return at a later date to conclude the investigation.

Exit interview conducted with Malika Binns/Site Supervisor report, appeal rights and notice of site visit issued.

Notice of Site Visit must be posted for 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2023
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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