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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334841751
Report Date: 01/26/2023
Date Signed: 01/26/2023 03:37:51 PM


Document Has Been Signed on 01/26/2023 03:37 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:
334841751
ADMINISTRATOR:MARIA ELENA DIAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 525-3084
CITY:RIVERSIDESTATE: CAZIP CODE:
92505
CAPACITY:14CENSUS: 0DATE:
01/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Maria Elena DiazTIME COMPLETED:
03:40 PM
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On 01/26/2023 at 2:55PM Licensing Program Analysts (LPAs) Giselle Carbullido and Claudia Caywood arrived at the facility to conduct a case management due to Licensee initiated consideration of inactive status. LPAs were granted entry by Licensee, Maria Diaz. Licensee considered facility closure but has opted to to inactive at this time.

Licensee informed LPAs that they are not currently operating the day-care and submitted LIC9211 Request for inactive status effective January 23, 2023. LPAs explained and discussed Inactive status and the Licensee agreed to the following: Licensee will not provide child care for which a license is required until their license is reactivated. Licensee will continue to pay the annual license fee by the annual date due. Licensee understands that failure to pay the annual license fees will result in the closure of the facility.

Licensee will inform the Licensing Office (RO) of any changes in the inactive dates by submitting a new LIC9211, before the expiration date. Licensee understands an annual inspection may be or is necessary prior to re-opening the facility and will contact the assigned analyst prior to reopening to schedule an inspection.

Licensee will comply with all, including new, licensing laws and regulations upon re-opening the facility, including but not limited to: Ensuring all adult staff, residents, and children who turn 18 during the inactive period, have criminal record clearances and TB.

Licensee will ensure compliance with all new legislation and/or regulations. Licensee will maintain current CPR, First Aid, and Mandated Reporter Certifications. Licensee will maintain a current fire extinguisher, carbon monoxide, and functioning smoke alarms and/or detectors. An exit interview was conducted with Licensee, Maria Diaz; and a copy of this report, notice of site visit and appeal rights were provided during this visit.

SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Giselle CarbullidoTELEPHONE: (951) 970-1904
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023
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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