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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844094
Report Date: 10/28/2021
Date Signed: 10/28/2021 03:45:02 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:CORONADO FAMILY CHILD CAREFACILITY NUMBER:
334844094
ADMINISTRATOR:CORONADO, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 807-3394
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:14CENSUS: 3DATE:
10/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:26 PM
MET WITH:Maria CoronadoTIME COMPLETED:
03:53 PM
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On this date 10/28/2021, Licensing Program Analyst (LPA) Ana Noble conducted a case management inspection and delivered amended report, page 2 of 2, that were initially provided to the facility on 10/08/2021. LPA Noble obtained Licensee signature and copy of amended page 2 of 2 was provided to Licensee.

No deficiencies were cited on this date. An exit interview was conducted with Maria Coronado, Licensee, a Notice of Site Visit (LIC 9213) was posted, appeal rights were discussed and provided, and a copy of this report was given to Mrs. Coronado.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Ana NobleTELEPHONE: (951) 782-6646
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2021
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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