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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844398
Report Date: 11/06/2020
Date Signed: 11/06/2020 10:01:38 AM

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:LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
334844398
ADMINISTRATOR:YANIRA LOPEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 564-2696
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:14CENSUS: 6DATE:
11/06/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Yanira LopezTIME COMPLETED:
10:00 AM
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On November 6, 2020, Due to COVID-19, Licensing Program Analyst (LPA) Yolanda Jackson conducted a tele-inspection Case Management Visit. The Unusual Incident Report was received by the Licensing Agency on November 2, 2020. LPA met with the Licensee, Yanira Lopez. There was a witness that was not available during the visit. LPA will conclude the investigation at another time.

An exit interview was conducted via Face-time, LPA Jackson provided the applicant with a copy of this report via email, LPA asked the Applicant to acknowledge receipt of the email. An electronic “Read receipt” was also attached. The electronic read receipt of the emailed report acknowledges receipt of this report. A copy of this report was emailed to the Applicant during this Tele-inspection on November 6, 2020.

A copy of this report was left with the Licensee and a copy must be made available upon request, to the public, for 3 years.
SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Yolanda JacksonTELEPHONE: (951) 201-1991
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2020
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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