364808239-1-7-2025-09-CC-ALAA-DCPPLX-20250107102529

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 364808239
Report Date: 01/07/2025
Date Signed: 01/07/2025 10:25:38 AM

Document Has Been Signed on 01/07/2025 10:25 AM - 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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME:	DIAZ FAMILY CHILD CARE		FACILITY NUMBER:	364808239
ADMINISTRATOR/ DIRECTOR:	ELSA DIAZ		FACILITY TYPE:	810
ADDRESS:			TELEPHONE:	(909) 621-7268
CITY:	MONTCLAIR	STATE: CA	ZIP CODE:	91763
CAPACITY: 14	TOTAL ENROLLED CHILDREN: 14	CENSUS: 8	DATE:	01/07/2025
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Elsa Diaz		TIME VISIT/ INSPECTION COMPLETED:	10:35 AM

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On the date and time listed above, Licensing Program Analysts (LPAs) Aman Lama and Chase Atherton conducted an unannounced case management visit to follow up on a Confirmation of Removal for Ramon Diaz. LPAs were greeted by Licensee, Elsa Diaz and granted entry into the facility. Present during this visit were: licensees assistant, Ramon Diaz and 8 children. Later, another 2 adults were also present in the home.

LPAs explained the purpose of the visit and explained the written Confirmation of Removal for Ramon Diaz. The licensee stated that Ramon Diaz is their son and still resides in the home as of this date, 01/07/2025.

The licensee was provided a copy of the Exemption Denial and Confirmation of Removal letter for Ramon Diaz from the Family Child Care Home (FCCH). The licensee was provided a copy of Addendum to Notification of Parent’s Rights (LIC 995B) which is to be signed by each child’s parent or guardian, a copy is to be provided to each child’s parent or guardian, and the original placed in each child’s file. Licensee stated they understand that failure to have form LIC 995B signed by parent/guardian, failure to provide a copy to the parent/guardian, and failure to have original form placed in each child’s file could result in a civil penalty of $100.00 per family.

Based on licensees own admission during today’s inspection, the LPAs have verified that Ramon Diaz was present during today’s visit. Licensee, Elsa Diaz stated that they will be have Ramon Diaz removed from the home, and no longer reside at this residence within 5 days of the date of this notice.

Gilbert Sena	TELEPHONE: (951) 782-4200
Aman Lama	TELEPHONE: (951) 970-7385
	DATE: 01/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: DIAZ FAMILY CHILD CARE	FACILITY NUMBER: 364808239
	VISIT DATE: 01/07/2025

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Licensee was provided a copy of the exemption denial letter, along with LIC300B. Licensee agrees to submit the Confirmation of Removal (LIC300B) to the Riverside Regional Office (RRO) upon removal of individual, within 5 days of the date of this notice. Additionally, licensee agrees to submit an updated
LIC279A, application form to confirm current adults residing in the home.

LPA will return at a later date to confirm the removal of the individual, Ramon Diaz.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

During the exit interview, the licensee, Elsa Diaz confirmed that there are no Registered Sex Offenders living in the facility.

Exit interview conducted and report was reviewed with the licensee, Elsa Diaz.

SUPERVISOR'S NAME: Gilbert Sena	TELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Aman Lama	TELEPHONE: (951) 970-7385
LICENSING EVALUATOR SIGNATURE:	DATE: 01/07/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

LIC809 (FAS) - (06/04)

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