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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334819620
Report Date: 02/18/2020
Date Signed: 02/18/2020 11:23:58 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MACIEL FAMILY CHILD CAREFACILITY NUMBER:
334819620
ADMINISTRATOR:MACIEL, MARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 343-5924
CITY:THOUSAND PALMSSTATE: CAZIP CODE:
92276
CAPACITY:14CENSUS: 5DATE:
02/18/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Marina Maciel, LicenseeTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA), Carlos Martinez, made and unannounced Case Management visit on this date to deliver and amended LIC 9099. LPA met with Marina Maciel, Licensee, who was informed of the reason for the premise visit.


An exit interview was conducted, and a copy of this report was provided to the Licensee.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Carlos MartinezTELEPHONE: (951) 295-2190
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2020
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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