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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845343
Report Date: 03/23/2021
Date Signed: 03/23/2021 05:05:24 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:
03/23/2021
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
12:06 PM
MET WITH:Tailesha KinfTIME COMPLETED:
12:27 PM
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Licensing Program Analysts (LPAs) Otsanya Cameron and Jeanette Sanchez arrived at the facility to conduct a Case Management-Legal/Non-compliance visit. This was a follow-up visit to verify that all care and supervision of children has ceased, after a Temporary Suspension Order (TSO) on the license was served, effective 2/26/21 at close of business.

On this date LPAs observed the TSO posting that was placed on the front door remained posted. LPAs were met with licensee's son. Based on observation there did not appear to be any children present and Licensee was not home.

Licensee will be provided copy of report via email.
SUPERVISOR'S NAME: Dawn ParkerTELEPHONE: (951) 320-2101
LICENSING EVALUATOR NAME: Otsanya CameronTELEPHONE: (951) 970-1388
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2021
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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