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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334840487
Report Date: 07/08/2021
Date Signed: 07/08/2021 10:33:24 AM

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:HANSEN FAMILY CHILD CAREFACILITY NUMBER:
334840487
ADMINISTRATOR:HANSEN,BRENDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 734-5766
CITY:CORONASTATE: CAZIP CODE:
92878
CAPACITY:14CENSUS: 4DATE:
07/08/2021
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
08:36 AM
MET WITH:Paola Aguirre, AssistantTIME COMPLETED:
10:35 AM
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Licensing Program Analyst Jones arrived at the facility for the purpose of interviewing child(ren) regarding other matters at another facility. Census were taken and interview(s) were conducted.

No deficiencies cited during this visit.


An exit interview was conducted, a Notice of Site Visit was provided and must be posted for 30 days, and a copy of this report was provided to Paola Aguirre, Assistant.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse JonesTELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021
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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