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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334815209
Report Date: 09/16/2021
Date Signed: 09/16/2021 11:30:23 AM

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:ROTH FAMILY CHILD CAREFACILITY NUMBER:
334815209
ADMINISTRATOR:ROTH, MINDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 719-1134
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY:14CENSUS: 12DATE:
09/16/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Mindy RothTIME COMPLETED:
11:35 AM
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Licensing Program Analysts (LPAs) Ana Noble and Sumayya Habeebulla arrived at the facility and met with Mindy Roth, Licensee. LPA Noble provided the purpose of visit to conduct a case management visit regarding the recently installed pool. LPAs toured the facility, took census and inspected the pool fencing. LPAs inspection and measurement of the fencing indicate that the height of the fence is more than the 5 feet as required, the gate is self latching, self closing and latch is 4 inches from the top. The gate swings and opens away from the pool. LPA Noble took pictures of the pool area, playground, playhouse and rear of the home/backyard

However, there are windows and doors that lead into the pool area from the home. Children do not access this area the children play ground is located in a fenced area located by the front door entrance and the side yard. Ms. Roth stated that she had been communicating with the Department starting in March through July 2021. LPA will consult with Licensing Program Manager, regarding the windows and doors that lead to the pool area. LPA will conduct a follow up visit.

LPA conducted an exit interview with Mindy Roth, Licensee, and a copy of this report was provided on this date. This report must be kept available upon request for the next 3 year.

Notice of site visit was provided and must be posted in a prominent area for 30 days.



SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Ana NobleTELEPHONE: (951) 295-5832
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2021
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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