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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364813984
Report Date: 07/21/2021
Date Signed: 07/21/2021 04:02:26 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: 4DATE:
07/21/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:07 PM
MET WITH:Sarah VeraTIME COMPLETED:
04:01 PM
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An Unusual Incident Report (UIR) was received from the facility on 6/11/2021. It was reported that the facility was questioned by Child #1's parent regarding possible personal rights violation. Licensing Program Analysts (LPAs) Kim Leung and Corey Hall conducted a follow up inspection at the facility on 6/25/2021 in response to the receipt of the UIR. Interviews were conducted and records were reviewed during that inspection. LPA Kim Leung returned to the facility this date on 7/21/2021 to continue investigating the alleged incident. Prior to returning to the facility, additional interviews were conducted, medical report and other report pertaining to the alleged incident were obtained.

During this inspection, additional interview was conducted. During the investigation process, Community Care Licensing received no information to support any personal rights violations of any nature at this time. Based on the information obtained, no deficiency was cited at this time. Licensee was advised that the UIR would be reviewed again for further investigation if new information is received.

Exit interview was conducted with licensee Sarah Vera, Notice of Site Visit was issued and it must be posted near the front entrance for 30 days.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Kim LeungTELEPHONE: (951) 529-4713
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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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