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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842566
Report Date: 09/12/2019
Date Signed: 09/12/2019 04:45:37 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:RODRIGUEZ FAMILY CHILD CAREFACILITY NUMBER:
334842566
ADMINISTRATOR:RODRIGUEZ, CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 396-9244
CITY:MECCASTATE: CAZIP CODE:
92254
CAPACITY:14CENSUS: 0DATE:
09/12/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Carmen RodriguezTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA's) Nelson Zuniga and Diana Brasel arrived at the facility to follow-up on an Unusual Incident Report that was submitted on 09/11/2019. The report indicated that there was a possible lack of supervision and personal rights violations.

A toured of the facility was conducted by LPA Zuniga, facility records reviewed, and interviews were conducted.


Based on the information obtained during the inspections and interviews, there appeared to be no violation of Title 22 Regulations pertaining to the reported incident.


An exit interview was conducted and a copy of this report was reviewed and provided.
Notice of Site Visit issued.
A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Nelson ZunigaTELEPHONE: (951) 782-6634
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2019
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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