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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334815086
Report Date: 07/21/2022
Date Signed: 07/21/2022 02:06:18 PM


Document Has Been Signed on 07/21/2022 02:06 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:WHITE FAMILY CHILD CAREFACILITY NUMBER:
334815086
ADMINISTRATOR:WHITE, E. & ALLEN-WHITE,T.FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 679-8010
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY:14CENSUS: 0DATE:
07/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Tammy WhiteTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) James Wilkerson arrived at this facility to conduct a 1-Year Annual Visit. Upon arrival, licensee Tammy White stated that she hasn't had any day care children about a month ago and wishes to take a break from day care but not close. Ms. White filled out form LIC 9211 to request to go inactive from 07/21/22 until 07/21/23. It was discussed that annual fees will paid when due and that child care cannot be conducted while on an inactive status.

An exit interview was conducted, a Notice of Site Visit posted, appeal rights discussed and provided along with a copy of this report on this date to Ms. White.
SUPERVISOR'S NAME: Carlos MartinezTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: James WilkersonTELEPHONE: (951) 218-7031
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2022
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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