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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334830676
Report Date: 05/17/2023
Date Signed: 05/17/2023 09:44:02 AM


Document Has Been Signed on 05/17/2023 09:44 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 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:
05/17/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Marta De PerezTIME COMPLETED:
09:50 AM
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On 5/17/2023 at 09:01 AM, Licensing Program Analysts (LPAs) Claudia Caywood and Elyse Jones arrived at the facility to conduct a joint Case Management Health and Safety check of the facility. Upon arrival, LPAs were met by Marta De Perez and Jose Diaz, who stated licensee was not present. LPA contacted the licensee and stated the purpose of the visit. Licensee gave LPAs authorization to conduct the inspection without her being present. During the facility check, LPAs toured the facility (inside and outside), and took a census. No children present during the inspection. Inspection and exit interview was translated in Spanish.

While touring the facility, LPAs did not observe other adults in the home, or indication of any other adults, besides the adults listed above.

LPAs observed pool to be in compliance with Title 22 regulations.

No deficiencies cited.

An exit interview was conducted, and report was reviewed with the assistant, Marta De Perez. A Notice of Site Visit was issued and is to be posted in a prominent location at the facility for the next 30 days.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4800
LICENSING EVALUATOR NAME: Claudia CaywoodTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2023
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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