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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
334845419
Report Date:
07/03/2019
Date Signed:
07/03/2019 10:12:55 AM
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:
DAVIS FAMILY CHILD CARE
FACILITY NUMBER:
334845419
ADMINISTRATOR:
DAVIS,LATOYA
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(480) 823-2318
CITY:
MORENO VALLEY
STATE:
CA
ZIP CODE:
92557
CAPACITY:
14
CENSUS:
4
DATE:
07/03/2019
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
09:50 AM
MET WITH:
Latoya Davis
TIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Yolanda Jackson and Licensing Program Manager (LPM) Thelma Sandoval arrived at the facility to amend the Complaint Investigation Report that was issued on 6/26/19.
An exit interview was held and a copy of this report was provided at time of visit.
SUPERVISOR'S NAME:
Telma Sandoval
TELEPHONE:
(951) 782-4950
LICENSING EVALUATOR NAME:
Yolanda Jackson
TELEPHONE:
(951) 201-1991
LICENSING EVALUATOR SIGNATURE:
DATE:
07/03/2019
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/03/2019
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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