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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844604
Report Date: 09/27/2022
Date Signed: 09/27/2022 02:43:03 PM


Document Has Been Signed on 09/27/2022 02:43 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:CEJA FAMILY CHILD CAREFACILITY NUMBER:
334844604
ADMINISTRATOR:CEJA, JASMINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 848-5001
CITY:COACHELLASTATE: CAZIP CODE:
92236
CAPACITY:14CENSUS: 8DATE:
09/27/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:27 PM
MET WITH:Jasmin CejaTIME COMPLETED:
02:52 PM
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On September 27, 2022 at 2:10 pm, Licensing Program Analyst Ana Noble arrived at the facility to conducted a Case Management inspection initiated by the Licensee due to physical modifications made the home particularly the garage. LPA inspected the newly converted garage. The licensee has submitted copies of the City Permit, City Inspection history-Final Inspection Approval, New Fire Clearance-granted on 9/13/2022 and updated facility sketch. LPA Noble inspected the garage and observed no hazards. Licensee may now begin the use of the permitted converted garage.

Exit interview was conducted with Jasmin Ceja, Licensee, copy of this report, appeal rights and notice of visit was provided to licensee during the inspection. A copy of the report must be maintained for a total of 3 years and available to the public upon request.
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Ana NobleTELEPHONE: (951) 295-5832
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2022
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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