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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364820586
Report Date: 02/26/2024
Date Signed: 02/26/2024 02:40:27 PM

Document Has Been Signed on 02/26/2024 02:40 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:OCS-ST. ADELAIDE CATHOLIC PRESCHOOLFACILITY NUMBER:
364820586
ADMINISTRATOR:JOSIE GALLEGOSFACILITY TYPE:
850
ADDRESS:27487 E. BASELINETELEPHONE:
(909) 862-5851
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY: 60TOTAL ENROLLED CHILDREN: 60CENSUS: 0DATE:
02/26/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:29 PM
MET WITH:Director Josie GallegosTIME COMPLETED:
02:45 PM
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On 02/26/2024 at time listed above, Licensing Program Analyst (LPA) Steven Montoya arrived at the facility to conduct a CM Annual Continuation inspection. LPA was granted entry by Facility representative, Director Josie Gallegoes. LPA toured the facility, inside and out, reviewed staff and children records, and observed and/or discussed the following: LPA follow up on previous inspection.

On 2-22-2024, LPA conducted completed inspection. See Lic 809 dated 2-22-2024 for specific information. Note: prior inspection was not signed. LPA reviewed LIC809 and written copy was signed and will be file in RO.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov

Exit interview conducted and report was reviewed with the Facility representative , Director Josie Gallegos.

A notice of site visit was given and must remain posted for 30 days.





SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2024
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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