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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364830600
Report Date: 09/06/2023
Date Signed: 09/06/2023 11:24:28 AM

Document Has Been Signed on 09/06/2023 11:24 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:VOLUNTEERS OF AMERICAFACILITY NUMBER:
364830600
ADMINISTRATOR:RUBY CALDERONFACILITY TYPE:
850
ADDRESS:304 N. PEPPER AVENUETELEPHONE:
(909) 562-0901
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 190TOTAL ENROLLED CHILDREN: 190CENSUS: 46DATE:
09/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Ruby CalderonTIME COMPLETED:
11:35 AM
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On this date and time, Licensing Program Analyst (LPA) Laura Mejorado arrived at the facility to conduct a case management visit in response to the receipt of an unusual incident report (UIR). The UIR was received by the Riverside Child Care Regional office, on 09/05/23. The UIR documented an incident involving a child sustaining an injury while in care.

Upon arrival, LPA met with Director Ruby Calderon and stated the purpose of the visit. Records were reviewed and interviews were conducted. The subject child(ren) who was the subject of the UIR was not present during todays inspection.

Based on the information gathered and compiled during this inspection no citations were issued, at this time.

Exit interview conducted and report was reviewed with Director Ruby Calderon.

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

A copy of this report must be made available to the public, at the facility site, for 3 years.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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