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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364813984
Report Date: 06/25/2021
Date Signed: 06/25/2021 01:57:40 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:VERA FAMILY CHILD CAREFACILITY NUMBER:
364813984
ADMINISTRATOR:VERA, SARAHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 877-0370
CITY:RILATOSTATE: CAZIP CODE:
92376
CAPACITY:14CENSUS: 3DATE:
06/25/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Licensee Sarah VeraTIME COMPLETED:
02:10 PM
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On 6/25/21 at 12:20 pm, Licensing Program Analysts (LPAs) Corey Hall and Kim Leung arrived at the facility to follow up on an unusual incident report that was filed with the Riverside Regional Child Care Office on 6/11/21, regarding a possible personal rights violation.

LPAs met with Licensee Sarah Vera and informed her of the purpose of the visit. LPAs were granted access to the facility. LPAs toured the facility inside and out, took a census, reviewed records and conducted interviews.

Further information is needed. Therefore, this case management will be continued at a later date. Licensing will contact all pertinent parties to conclude the follow up to the unusual incident report.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Corey HallTELEPHONE: (951) 529-2439
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2021
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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