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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843589
Report Date: 06/05/2019
Date Signed: 06/05/2019 03:18:37 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:RIOS DE MEDINA FAMILY CHILD CAREFACILITY NUMBER:
334843589
ADMINISTRATOR:GLADIS RIOS DE MEDINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 398-3827
CITY:COACHELLASTATE: CAZIP CODE:
92236
CAPACITY:14CENSUS: 5DATE:
06/05/2019
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
02:53 PM
MET WITH:Gladis Rios De MedinaTIME COMPLETED:
03:30 PM
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Licensing Program Analyst Ana Noble arrived at the facility to conduct a Case Management visit. LPA toured the facility, took census and met with Licensee, Gladis Rios De Medina. During visit LPA confirmed that Licensee's, Mirian Medina-Cota does not live or work in the home. Ms. Rios De Medina stated that her sister in law has not assist her in the day-care for more than a year and a half. Ms. Rios De Medina, states that Ms. Medina-Cota does not reside at the facility and has never lived in the home. LPA informed Ms. Rios De Medina that Mirian Medina-Cota is excluded from the facility for the remainder of her life. Ms Rios De Medina stated that she received documentation from the Licensing Agency in regards to the Decision and Order that was adopted on 5/30/2019.

The Licensee stated that she understands the seriousness of this decision and will remain in compliance with Title 22 Regulations. LPA informed the Licensee that she must have Licensing form LIC 995B (Family Child Care Home Addendum To Notification Of Parents' Rights Regarding Removal/Exclusion) completed by newly enrolled parents. LPA also informed the Licensee that before working or living in the home, all adults must first receive a fingerprint clearance from the DOJ.

Based on evidence obtained during today's visit, the LPA has verified the individual is not present, employed or residing at the facility. LPA has advised the licensee to disassociate the individual from their roster.

An exit interview was held with Licensee, Ms. Rios De Medina.

A copy of this report shall be made available for 3 years for public review.

Verification of removal is complete.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Ana NobleTELEPHONE: (951) 782-3278
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2019
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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