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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364803437
Report Date: 08/25/2021
Date Signed: 08/25/2021 09:54:47 AM

Document Has Been Signed on 08/25/2021 09:54 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:FUSD/OAK PARKFACILITY NUMBER:
364803437
ADMINISTRATOR:DARCY WHITNEYFACILITY TYPE:
850
ADDRESS:14200 LIVE OAK AVENUETELEPHONE:
(909) 357-5696
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY: 24TOTAL ENROLLED CHILDREN: 0CENSUS: 18DATE:
08/25/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sharon NovelaTIME COMPLETED:
10:10 AM
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Licensing Program Analysts (LPAs) Taadhimeka Zeigler and Justin Giese conducted a case management visit to the facility to continue the investigation of an Unusual Incident Report that was received on August 17, 2021.

Facility records were reviewed and children were interviewed. Further information will be needed. Upon completion of the review, the outcome and/or recommendations will be provided to the licensee.

An exit interview was conducted and a copy of this report was provided to the Program Specialist.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taadhimeka Zeigler
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2021
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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