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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364817613
Report Date: 06/29/2023
Date Signed: 06/29/2023 03:19:32 PM


Document Has Been Signed on 06/29/2023 03:19 PM - It Cannot Be Edited

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:GARIVALDO FAMILY CHILD CAREFACILITY NUMBER:
364817613
ADMINISTRATOR:GARIVALDO, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 938-2898
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY:14CENSUS: 0DATE:
06/29/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Maria Garivaldo LicenseeTIME COMPLETED:
03:30 PM
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Licensing Program Analyst arrived at the facility to conduct a one year annual visit. LPA was greeted by the licensee upon arrival. The licensee advised LPA that she isn't operating currently and has not had any children since 12/2022. Due to personal reasons the licensee has requested to be placed onto Inactive status. Currently there are no children enrolled or present at the facility.

LPA provided an Inactive Request form for the licensee on this date. The form was completed and signed by the licensee, LPA will process the request and place the facility onto Inactive status as of 06/30/2023.

An exit interview was conducted and a copy of this report was provided on this date.
A Notice of Site visit was provided for posting until placed onto Inactive status.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Diana BraselTELEPHONE: 951-205-9491
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2023
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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