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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844715
Report Date: 07/16/2019
Date Signed: 07/16/2019 04:17:20 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:CORDOVA FAMILY CHILD CAREFACILITY NUMBER:
334844715
ADMINISTRATOR:GABRIELA CORDOVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 396-0973
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:14CENSUS: 14DATE:
07/16/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:GABRIELA CORDOVATIME COMPLETED:
04:25 PM
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On date and time noted, Licensing Program Manager Dawn Parker and Licensing Program Analysts (LPAs) John Huynh and Otsanya Cameron conducted a Random Annual Inspection using the Inspection Tool as part of the Inspection Tool Pilot Project. This Inspection tool consists of a short staff interview; a review of both the physical plant, operation and records. The results of these reviews will be put into the standard inspection domain tools based upon this initial review, the inspection tool will determine whether a more comprehensive inspection is required into any one or more domains (you may refer to the Pilot Operations Program Manual located on the ccld.ca.gov website under Inspection Process Project and Child Care for more details). Following this inspection, the Licensee will be asked to sign the report acknowledging receipt. This report will be uploaded onto the transparency website. All appeal rights will apply to this report and explained to the licensee or representative during the exit interview. The Licensee will be sent a survey to provide their feedback on this inspection tool and this process.

This visit was also conducted with Licensing Program Manager (LPM) Dawn Parker who completed the inter-rater reliability inspection.

Present during this visit were the Licensee, Gabriela Cordova, Assistant Jacqueline Ramirez and Assistant Guadalupe Ramirez. Due to time constraints LPAs and LPM could not complete the inspection today but will return on a different date.

A copy of this report was provided to the applicant on this date and must be made available to the public upon request for the next 3 years.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: John HuynhTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2019
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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