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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334830676
Report Date: 04/03/2023
Date Signed: 04/03/2023 01:52:13 PM


Document Has Been Signed on 04/03/2023 01:52 PM - It Cannot Be Edited

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:DIAZ FAMILY CHILD CAREFACILITY NUMBER:
334830676
ADMINISTRATOR:DIAZ, LORENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 785-8978
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:14CENSUS: 0DATE:
04/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Lorena DiazTIME COMPLETED:
02:00 PM
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On date and time listed, Licensing Program Analyst (LPA) arrived at the facility to conduct a unannounced Case Management visit. Present during this inspection was Licensee, Lorena Diaz.

LPA did not observe any children in care, however;

Licensee stated they will pick up 4 school age children later in the afternoon. LPA toured the facility, inside and out and the following was observed and/or discussed:

Normal days and hours of operation are: Monday - Friday 6:00am to 6pm
OFF-LIMIT AREAS INCLUDE: Three of four bedrooms, office, and backyard (where the pool is located)

ยท There is an in-ground pool located in the back yard. The pool is gated with a five foot mesh fence, which has a self latching/closing door. The pool is gated in compliance with Title 22 regulations, at this time.

LPA did not observe any Deficiencies during this visit

Exit interview conducted and report was reviewed with the licensee, Lorena Diaz.
A notice of site visit was given:

THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Justin GieseTELEPHONE: (951) 204-4847
LICENSING EVALUATOR SIGNATURE:
DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/03/2023
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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