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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845187
Report Date: 04/11/2024
Date Signed: 04/11/2024 02:33:20 PM


Document Has Been Signed on 04/11/2024 02:33 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:PETERSON FAMILY CHILD CAREFACILITY NUMBER:
334845187
ADMINISTRATOR:BRITTNEY PETERSONFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 534-3418
CITY:PALM DESERTSTATE: CAZIP CODE:
92211
CAPACITY:14CENSUS: 7DATE:
04/11/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:46 PM
MET WITH:Brittney PetersonTIME COMPLETED:
01:00 PM
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On April 11, 2024, Licensing Program Analyst (LPA) Lorena Valenzuela conducted an unannounced inspection at Peterson Family Child Care home and met with licensee Brittney Peterson. The purpose of this inspection is to discuss information received during a review of an incident that occurred at the facility.

Confidential interviews conducted revealed the facility did not report an incident to the Department that occurred on or around November 17, 2023, which involved Child 1 (C1) requiring medical attention after incident that occurred at the facility.

Based on interviews and records review, the Department finds the facility did not comply with the reporting requirements. Title 22, Section 102416.2 (b) (1) Reporting Requirements.

A signed copy of this report, LIC 809-d, and Appeal Rights, and was provided to Brittney Peterson.

SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Lorena ValenzuelaTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 04/11/2024 02:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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


FACILITY NAME: PETERSON FAMILY CHILD CARE
FACILITY NUMBER: 334845187

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/19/2024
Section Cited
CCR
102416.2(b)(1)

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102416.2 (b) (1)Reporting Requirements The licensee shall report to the Department any of the events...that occur during the operation of the family child care home. (1) Medical treatment means treatment by a medical professional...
This requirement was not met as evidence by:
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Licensee states will submit written statement/plan to the Department it regard to how licensee will meet the reporting requirements, will submit to the Department by 04/19/2024.
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Based on interviews and records review licensee did not submit an unusual incident report in regard to Child 1 requiring medical attention after an incident that occurred at the facility November 2023. This poses a potential risk to the health, safety and personal rights of the children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 505-6334
LICENSING EVALUATOR NAME: Lorena ValenzuelaTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2