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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818290
Report Date: 09/29/2022
Date Signed: 09/30/2022 08:59:30 AM


Document Has Been Signed on 09/30/2022 08:59 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501



FACILITY NAME:LINDO FAMILY CHILD CAREFACILITY NUMBER:
364818290
ADMINISTRATOR:LINDO, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 258-3416
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY:14CENSUS: 5DATE:
09/29/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Licensee, Diana LindoTIME COMPLETED:
05:15 PM
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On 09/29/2022, Licensing Program Analyst (LPA) Destinee Hogue conducted a case management inspection, in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 02/22/2022 and initiated by the Department on 03/03/2022. The following was discussed with Licensee, Diana Lindo:

Licensee, Diana Lindo self-reported an incident that occurred outside the facility and involved a minor child of the residence. Based on the information disclosed, the reported incident did not involve any day care children and occurred outside the residence.

Based on the reported information, there appears to be no violations of Title 22 Regulations pertaining to the reported incident, at this time.



A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee [or facility representative] (include name).

SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 248-0228
LICENSING EVALUATOR NAME: Destinee HogueTELEPHONE: (951) 218-5196
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022
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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