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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844522
Report Date: 12/20/2023
Date Signed: 12/20/2023 12:58:57 PM


Document Has Been Signed on 12/20/2023 12:58 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:MONTENEGRO FAMILY CHILD CAREFACILITY NUMBER:
334844522
ADMINISTRATOR:MONTENEGRO, YVONNEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 219-2886
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY:14CENSUS: 0DATE:
12/20/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Yvonne MontenegroTIME COMPLETED:
01:15 PM
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On December 20, 2023 at 12:25 PM, Licensing Program Analyst (LPA) Courtnee Peebles conducted an unannounced case management inspection at FCCH. The purpose of the inspection was to inspect a pool that was recently installed. LPA inspected the pool fencing with licensee and pictures were taken. Licensee has completely fenced off the right side of the home where the in ground pool is built. Licensee has also placed alarms on the doors in the main off limits entrance to the home to prevent access by children. The fencing does meet Title 22 regulations at this time and the right side of the backyard will remain off limits.

An exit interview was conducted, this report, appeal rights and notice of site visit was provided to licensee.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 782-6641
LICENSING EVALUATOR NAME: Courtnee PeeblesTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:
DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/20/2023
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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