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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334820991
Report Date: 05/28/2020
Date Signed: 05/28/2020 04:10:01 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:GRAJEDA FAMILY CHILD CAREFACILITY NUMBER:
334820991
ADMINISTRATOR:GRAJEDA, ANTOINETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 277-4391
CITY:CORONASTATE: CAZIP CODE:
92883
CAPACITY:14CENSUS: 0DATE:
05/28/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Antoinette GrajedaTIME COMPLETED:
02:20 PM
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On 05/28/20 at 1:00pm Licensing Program Analyst (LPA) Giselle Carbullido conducted a case management Tele- Inspection via Facetime with Licensee, Antoinette Grajeda for the purpose of observing construction for room additions. Due to the executive order issued by Governor Newsom on March 16, 2020 regarding COVID-19 pandemic, this investigation was conducted via Tele-inspection. LPA discussed purpose of tele visit, took census, toured the facility and requested/obtained records electronically.

At 1:30pm LPA observed that the area under construction is located on the front right side of the home. The entire area for construction is cordoned off by wood walls and is completely inaccessible to children in care. Licensee noted that the room additions will consist of 2 rooms and a bathroom. Per the Licensee, once construction is completed the 2 rooms and bathroom will be off limits. Licensee submitted new sketch to the LPA and informed LPA construction is estimated to be completed by September 2020. Licensee will contact LPA when construction is completed.

LPA observed from the sketch and from Licensee the areas of operation for the day care have not changed and consist of: the living room, kitchen, bathroom, indoor playroom and outside play area. The rest of the home and construction areas remain off limits.

LPA informed Licensee once construction is complete another tele inspection will need to be conducted to verify construction was completed within code and obtain final inspection documents.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2020
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: GRAJEDA FAMILY CHILD CARE
FACILITY NUMBER: 334820991
VISIT DATE: 05/28/2020
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An exit interview was conducted, and LPA Carbullido provided Ms. Grajeda, Licensee with a copy of this report via email with an electronic “read receipt” request. The electronic read receipt of the emailed report acknowledges receipt of this report. A copy of this report was emailed to Licensee for this Tele-inspection on May 28, 2020.

This report must be made available to the public upon request for three years.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2020
LIC809 (FAS) - (06/04)
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