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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334830295
Report Date: 07/03/2020
Date Signed: 07/03/2020 02:23:13 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:JACOBS FAMILY CHILD CAREFACILITY NUMBER:
334830295
ADMINISTRATOR:JACOBS, CHRISTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 208-3001
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:14CENSUS: 4DATE:
07/03/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Christina JacobsTIME COMPLETED:
02:25 PM
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Due to COVID-19, Licensing Program Analyst (LPA) Yolanda Jackson conducted a Case Management Tele Inspection. Present during the inspection was the Licensee, Christina Jacobs and 4 children in care. The backyard was under construction in the playground area. LPA inspected the backyard that was previously off limits. LPA inspected the backyard and it is in substantial compliance.

An exit interview was conducted via Face-time, LPA Jackson provided the Licensee with a copy of this report via email, LPA asked the Licensee to acknowledge receipt of the email. An electronic “read receipt” was also attached. The electronic read receipt of the emailed report acknowledges receipt of this report. A copy of this report was emailed to the Licensee during this Tele-inspection on July 3, 2020.

A copy of this report was left with the Licensee and a copy must be made available upon request, to the public, for 3 years.
SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Yolanda JacksonTELEPHONE: (951) 201-1991
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2020
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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