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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364803437
Report Date: 12/13/2021
Date Signed: 12/13/2021 09:04:49 AM

Document Has Been Signed on 12/13/2021 09:04 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: 22CENSUS: 18DATE:
12/13/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Lisa JohnsonTIME COMPLETED:
09:20 AM
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Licensing Program Analysts (LPAs) Taadhimeka Zeigler and Eileen Corral conducted a case management visit to the facility to continue the investigation of an Unusual Incident Report that was received on August 17, 2021. It was alleged that a staff member grabbed a child's arm. Additional case management visits were conducted on 08/23/2021 and 08/25/2021.

Facility records were reviewed and children and staff were interviewed. LPA also obtained and reviewed additional records from another agency, which concluded that the incident was un-corroborated. Based on information gathered, the facility acted appropriately and no violations have been identified at this time.

An exit interview was conducted and a copy of this report was provided to facility staff.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taadhimeka Zeigler
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2021
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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