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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881048
Report Date: 12/27/2024
Date Signed: 12/27/2024 10:55:55 AM

Document Has Been Signed on 12/27/2024 10:55 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:AQUA RIDGE OF MONTCLAIRFACILITY NUMBER:
361881048
ADMINISTRATOR/
DIRECTOR:		MONIQUE DEL JUNCOFACILITY TYPE:
740
ADDRESS:9631 MONTE VISTA AVETELEPHONE:
(909) 483-2782
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY: 115CENSUS: 70DATE:
12/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Debora Main, Community Relations DirectorTIME VISIT/
INSPECTION COMPLETED:
11:10 AM
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On 12/27/2024 at 9:10 AM, Licensing Program Analyst (LPA) Eldin Serrano arrived at the facility unannounced to conduct a Case Management Visit for health and safety check. This case management visit is in response to a phone call received at the Community Care Licensing Office on 12/24/2024. LPA was greeted by Community Relations Director (CRD) Debora Main at the front lobby. LPA introduced self and stated purpose of the visit.

During today's visit, LPA discussed the purpose of the visit to Community Relations Director Deborah Main. LPA did a health and safety check and interviewed staff..

No deficiencies were observed during this visit. An exit interview was conducted where this report was, reviewed, discussed and then provided to CRD Debora Main.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2024
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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