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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364807680
Report Date: 10/29/2019
Date Signed: 10/29/2019 11:03:33 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GEORGE FAMILY CHILD CAREFACILITY NUMBER:
364807680
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
10/29/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Yvonne GeorgeTIME COMPLETED:
11:15 AM
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On date and time listed, Licensing Program Analyst (LPA) Fe Floria arrived at the facility to conduct a required annual random however the visit was changed to a Case Management because the kitchen and the backyard are under repairs and will last for another 2 weeks. LPA was granted entrance by the Licensee Ms. Yvonne who had her adult daughter and 4 grandchildren present in the home. States that she had no other day care children aside from her own grandchildren for about a month in anticipation of the repairs. The LPA informed the Licensee that an annual random inspection is required when the repairs are completed and she will inform the Department as to when the visit can be done.

An exit interview was conducted with the Licensee and a copy of this report was provided on this date.

This report will be available to the public for three years.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Fe FloriaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2019
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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