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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844514
Report Date: 09/13/2019
Date Signed: 09/13/2019 09:50:40 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:ROMERO FAMILY CHILD CAREFACILITY NUMBER:
334844514
ADMINISTRATOR:ROMERO, JUANITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 443-1494
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:14CENSUS: 4DATE:
09/13/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Juanita RomeroTIME COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Yolanda Jackson arrived at the facility to conduct a Case Management Visit. The Licensee had construction done at the facility and added a room addition to the facility. The Licensee informed Licensing of the room addition on 7/24/19. LPA inspected the room that will to used for the day care. LPA observed the City of Perris Permit, dated 7/19/19 and updated facility sketch. The day care room is in substantial compliance with Title 22 Regulations.

A copy of this report was provided to the licensee on this date.
SUPERVISOR'S NAME: Telma SandovalTELEPHONE: (951) 782-4950
LICENSING EVALUATOR NAME: Yolanda JacksonTELEPHONE: (951) 201-1991
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2019
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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