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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844834
Report Date: 04/19/2024
Date Signed: 04/19/2024 01:53:18 PM


Document Has Been Signed on 04/19/2024 01:53 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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:ADAMS FAMILY CHILD CAREFACILITY NUMBER:
334844834
ADMINISTRATOR:ADAMS,DONISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 430-5012
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92532
CAPACITY:14CENSUS: 8DATE:
04/19/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Donisha Adams TIME COMPLETED:
02:00 PM
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On the date and time listed above, Licensing Program Analyst (LPA) Gabriela Hernandez and Licensing Program Manager (LPM) Pauline Beschorner arrived at the Family Child Care Home for a case management - plan of correction inspection. LPA met with the Licensee and explained the reason for today’s visit.

LPA and LPM observed the pool fencing and pictures were taken. The mesh fencing surrounds the entire pool and is over 5 feet tall. The mesh fencing has one gate within the fencing that opens away from the pool, self-closes and self-latches. As of this date the fencing has been corrected and meets Title 22 Requirements. LPA advised licensee to be vigilant of any wear and tear on the fencing, gate, spring and latch and ensure it continues to meet requirements.

The citation issued on 3/19/24 was cleared during this visit and a "Letter of Deficiency Citation Cleared" was provided. An exit interview was conducted. A copy of this report along with appeals were provided.

A notice of site was provided and shall remain posted for 30 days.
SUPERVISOR'S NAME: Pauline BeschornerTELEPHONE: (951) 255-4093
LICENSING EVALUATOR NAME: Gabriela HernandezTELEPHONE: 951-782-4200
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2024
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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