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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334830676
Report Date: 06/13/2023
Date Signed: 06/13/2023 09:29:03 AM


Document Has Been Signed on 06/13/2023 09:29 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: 1DATE:
06/13/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Lorena DiazTIME COMPLETED:
09:40 AM
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On 6/13/2023 at 08:53 AM, Licensing Program Analyst (LPA) Claudia Caywood arrived at the facility to conduct a Case Management Legal/Non-compliance check. Upon arrival, LPA was met by Marta De Perez, who stated licensee was not present but on her way back to the facility. LPA contacted the licensee and stated the purpose of the visit. LPA conducted the inspection without her being present. During the facility check, LPA toured the facility (inside and outside), and took a census. One child was present during the inspection.

While touring the facility, LPA did not observe other adults in the home, or indication of any other adults, besides Marta De Perez.

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

No deficiencies cited.

An exit interview was conducted, and report was reviewed with the Licensee, Lorena Diaz. 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: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/13/2023
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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