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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845343
Report Date: 02/26/2021
Date Signed: 02/26/2021 02:18:43 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:KING FAMILY CHILD CAREFACILITY NUMBER:
334845343
ADMINISTRATOR:KING,TAILESHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 518-5169
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:14CENSUS: 0DATE:
02/26/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Tailesha KingTIME COMPLETED:
02:22 PM
NARRATIVE
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Regional Manager (RM) Lya Johnson, Licensing Program Analyst (LPA) Otsanya Cameron visited the facility for the purpose of serving a Temporary Suspension Order (TSO) on the license, effective 02/26/21 at close of business. Regional Manager Lya Johnson and LPA Otsanya Cameron were granted access into the home by the licensee.

The TSO process was explained by RM Lya Johnson and all documents were provided to Ms. Tailesha King, which include: Temporary Suspension Order, Statement to Respondents, Government Code Statues, Summary Instructions for Licensee, Summary of Charges, Accusation, Confidential Names List, Request for Discovery and Notice of Defense (2 copies).

RM Lya Johnson explained the contents of the TSO packet to the Licensee. The Licensee was advised that all care and supervision of children must cease today, February 26, 2021 at close of business. LPA Otsanya Cameron posted the notice on the front door and the Licensee was informed that removing or concealing this notice while the TSO is in effect is punishable as a misdemeanor with a fine of up to $500.00. RM Johnson explained the above documents, appeal process and TSO process to the Licensee.
. Appeal rights were discussed and provided on this date.

An exit interview was conducted with Tailesha King and a copy of this report was provided to the licensee on this date, 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: Otsanya CameronTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021
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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