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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843618
Report Date: 09/29/2021
Date Signed: 09/29/2021 04:02:49 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:ALIPIO & GLORIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
334843618
ADMINISTRATOR:ALIPIO,GLORIA/GLORIA ZAIDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 302-8802
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:14CENSUS: 5DATE:
09/29/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:54 PM
MET WITH:Gloria AlipioTIME COMPLETED:
04:30 PM
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Licensing Program Analysts (LPAs) Ana Noble and Sumayya Habeebulla, arrived for another purpose and during this visit LPA Noble cleared pending Plan of Correction (POCs), issued on 9/8/2021 during an annual visit. LPAs met with Gloria Alipio, Licensee toured the facility and took census.

The following POCs were cleared for the following deficiencies during this inspection:
1. 102421 Child's Records (a) The licensee shall maintain, in each child's record, the signed and dated notice forms required.
2. 102417(A)(1) Each family child care home shall conduct fire drills and disaster drills at least once every six months of each drill.
3. 102416(c) Licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first.

All were cleared during this inspection, exit interview conducted, a copy of this report was provided to the Licensee. Report must be available upon request for public review for 3 years.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Ana NobleTELEPHONE: (951) 295-5832
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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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