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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334817354
Report Date: 01/28/2020
Date Signed: 01/28/2020 12:17:30 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:MARMOLEJO FAMILY CHILD CAREFACILITY NUMBER:
334817354
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
01/28/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:Diana MarmolejoTIME COMPLETED:
12:45 PM
NARRATIVE
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On January 28, 2020 at 10:08 A.M., Licensing Program Analysts (LPAs) Elyse Jones, Destinee Hogue and Blance Ruiz-Silva arrived at the facility to conduct a Case Management inspection to confirm the removal of Clarisa Marmolejo. An Immediate Action Required-Exemption Needed OUT (CBCB-3) was mailed to the facility notifying the Licensee of a criminal record exemption needed for Clarisa Marmolejo. Licensee stated she has not received the Confirmation of Removal via mail. LPAs met with Diana Marmolejo to discuss the CBCB-3 in detail.

Licensee Diana Marmolejo, understands the individual above cannot work, reside, or be present at the facility until a criminal record exemption is granted. Pursuant to state law, an exemption may be granted if the Caregiver Background Check Bureau is in receipt of substantial and convincing evidence that the individual is a present good character. Licensee understands a signed and dated copy of an LIC 995B Addendum to Notification of Parent's Rights must be placed in the file of children who are currently enrolled and any children who enroll in the future.

Based upon the evidence obtained during today's inspection it was verified Clarisa Marmolejo is residing in the facility. Licensee stated she is unable to remove Clarisa Marmolejo from the home at this time. Licensee agrees to submit a written statement within 24 hours stating what her plan is to be in compliance with the regulations.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse JonesTELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: MARMOLEJO FAMILY CHILD CARE
FACILITY NUMBER: 334817354
VISIT DATE: 01/28/2020
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No deficiencies were cited during this inspection. A Notice of Site Visit was issued and LPAs verified it was posted in a prominent location at the facility before leaving. The Licensee understands it must remain posted for the next next 30 days. The report must be available for review, upon request, for the next three years.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse JonesTELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
LIC809 (FAS) - (06/04)
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