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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334841590
Report Date: 02/24/2021
Date Signed: 02/24/2021 03:04:12 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
334841590
ADMINISTRATOR:LOPEZ, ROSARIOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 722-7920
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY:14CENSUS: 4DATE:
02/24/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Rosario Lopez TIME COMPLETED:
02:00 PM
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Due to COVID-19 pandemic, on February 24, 2021. Licensing Program Analyst (LPA) Timeka Reed conducted a Tele-inspection. Due to the executive order issued by Governor Newsom on March 16, 2020 regarding COVID-19, this inspection was conducted telephonically.

On the above date, LPA Reed delivered an amended LIC 9099 Licensing Report dated February 5, 2021.

LPA Reed discussed the Licensing Report issued on February 5, 2021 with Licensee as well as modified the Plan of Correction issued as a result of the findings.

A copy of this report was provided to Rosario Lopez.

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SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Timeka ReedTELEPHONE: (951) 970-1161
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2021
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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