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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364808239
Report Date: 01/14/2025
Date Signed: 01/14/2025 10:49:21 AM

Document Has Been Signed on 01/14/2025 10:49 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 CAREFACILITY NUMBER:
364808239
ADMINISTRATOR/
DIRECTOR:		ELSA DIAZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 621-7268
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
01/14/2025
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Elsa DiazTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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On the date and time listed, 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, a cleared resident on the roster and 7 children.

LPAs explained the purpose of the visit. A previous inspection was conducted on 01/07/2025. During the previous inspection, LPAs explained the written Confirmation of Removal for Ramon Diaz. During todays inspection the licensee, Elsa Diaz, stated that Ramon Diaz is their son and no longer resides in the home as of 01/11/2025. LPAs confirmed this by touring the facility. Licensee, Elsa Diaz, presented a copy of the signed copy of the Confirmation of Removal, but had the wrong date on there. LPAs took a picture of the copy of the Confirmation of Removal provided by licensee, Elsa Diaz and collected a correct copy with the correct date of removal of 01/11/2025. Licensee also provided a copy of an updated LIC279 including residents of the home. Ramon Diaz has been removed from the LIC279.

LPAs also checked a few children's files and confirmed Notification of Parent’s Rights (LIC 995B) has been filled out and signed. Licensee understands 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.

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

An exit interview was conducted and report was reviewed with licensee, Elsa Diaz.
Gilbert SenaTELEPHONE: (951) 782-4200
Aman LamaTELEPHONE: (951) 970-7385
DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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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