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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844715
Report Date: 10/26/2022
Date Signed: 10/26/2022 04:57:39 PM


Document Has Been Signed on 10/26/2022 04:57 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 ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:CORDOVA FAMILY CHILD CAREFACILITY NUMBER:
334844715
ADMINISTRATOR:CORDOVA,GABRIELAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 396-0973
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:14CENSUS: 0DATE:
10/26/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee, Gabriela CordovaTIME COMPLETED:
05:00 PM
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On 10/26/2022, an Informal Conference was held at the Riverside Regional Office. Present in the conference were Licensee, Gabriela Cordova; Licensing Program Manager (LPM) Kimberly Williams; and Licensing Program Analysts (LPAs) Destinee Hogue and Claudia Caywood.

The conference was held to discuss the following sections of Title 22 Regulations and Health and Safety Code:

1) Criminal Record Clearance
2) Staffing Ratio and Capacity
3) Operation of a Family Child Care Home
4) Personnel Records
5) Fire Safety Clearance

Facility's non-compliance history was reviewed during the conference. Licensee agrees to submit the following by Friday, October 28, 2022: (1) Contact Care Provider Management Bureau (CPMB) and obtain an update on exemption status for pending fingerprints. (2) Submit proof that LIC9224-Acknowledgement of Receipt of Licensing Reports was provided to enrolled families (within 24 hours of next day in care); and (3) Submit an updated facility roster.

During today's conference, hard copies of documents were discussed and provided to Licensee related to Title 22 Regulations and Health & Safety Code sections identified above; and an amended LIC421 for the Complaint inspection dated 10/06/22.

Technical Support Program (TSP) was discussed and information related to TSP was provided to Licensee. Licensee has an option to enroll in TSP. If Licensee agrees to enroll in TSP, she agrees to notify the Department within 30 days of this report.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 334844715
VISIT DATE: 10/26/2022
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Licensee was advised to visit the Department's website at: https://cdss.ca.gov/inforesources/child-care-licensing/resources-for-providers on a regular basis for licensing updates. Licensee was advised to review Family Child Care Provider videos related to: Child Care Reporting Requirements; Supervising Children in Family Child Care; Children's Personal Rights in Child Care; Record Keeping in Family Child Care; Background Check Requirements for Caregivers Child Care Provider video website link was provided to the Licensee during this conference.

During this conference, contact information of the local Resource and Referral Agency, Riverside County Office of Education (RCOE) at (951)826-6626 was provided to Licensee. Licensee agrees to ensure that the facility is operating in substantial compliance of California Code of Regulations Title 22, Division 12.

An exit interview was conducted Licensee, Gabriela Cordova.
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
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