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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364816744
Report Date: 09/11/2020
Date Signed: 09/11/2020 10:18:29 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:RABUN FAMILY CHILD CAREFACILITY NUMBER:
364816744
ADMINISTRATOR:RABUN, DEMETRIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 762-8265
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91739
CAPACITY:14CENSUS: 5DATE:
09/11/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Demetria Rabun/LicenseeTIME COMPLETED:
10:30 AM
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On 9/11 at 10:02 AM Licensing Program Analyst (LPA) Patricia Berry conducted a case management -licensee initiated tele-visit. LPA conducted the tele-visit via FaceTime due to COVID-19 and social distancing purposes. LPA toured facility and took a census. The reason for the tele-visit was to observe the above- ground pool for compliance with Title 22 regulations.

LPA observed the above ground pool to measure a little over 5 ft around (licensee measured fence with LPA on FaceTime). LPA observed gate swings away from the pool, self-closes and has a self-latching key-locked device located no more than six inches from the top of the gate.


LPA observed a living room window that leads to the backyard and is right next to the pool. LPA observed the window has an alarm on it, so if anyone opens that window an alarm will sound.

LPA observed the above-ground pool to meet Title 22 regulations.

This report will be sent via email to the provided email address with an attached read receipt. A copy of the LIC 9213- Notice of Site Visit will be sent via email along with the report. The read receipt will be used in lieu of the signature on the report.

All reports shall be maintained for three years.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2020
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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