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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334820885
Report Date: 01/22/2020
Date Signed: 01/22/2020 10:22:10 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
334820885
ADMINISTRATOR:RODRIGUEZ, BLANCAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 732-0565
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:14CENSUS: 5DATE:
01/22/2020
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Blanca RodriguezTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Joanne Domingo arrived at the facility to conduct a child interview from a different facility. LPA Domingo met with licensee, conducted census and interviews.

NO DEFICIENCIES CITED DURING THIS VISIT.

A copy of this report was provided to the licensee on this date and must be made available to the public upon request for the next 3 years.
SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:

DATE: 01/22/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2020
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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