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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334810456
Report Date: 11/07/2019
Date Signed: 11/07/2019 02:26:15 PM

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:VELASCO FAMILY CHILD CAREFACILITY NUMBER:
334810456
ADMINISTRATOR:VELASCO, JUANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 361-3146
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:14CENSUS: 7DATE:
11/07/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Juana Velasco, LIcenseeTIME COMPLETED:
02:25 PM
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Licensing Program Analysts (LPA), Carlos Martinez, arrived to the facility to conduct a Plan of Corrections visit for deficiencies cited during Annual/Random conducted on 10/23/19. LPA met with Juana Velasco, Licensee, who granted LPA access to the facility.

During this visit, LPA observed that the deficiencies pertaining to OPERATION OF A CHILD CARE HOME, IMMUNIZATIONS, PERSONNEL REQUIREMENTS, AND MANDATED REPORTER have been corrected.


Exit interview was conducted with Ms. Velasco, and a copy was provided.

A copy of this report must be made available for 3 years for public review upon request
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Carlos MartinezTELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2019
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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