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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364830976
Report Date: 10/25/2021
Date Signed: 10/25/2021 09:48:58 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:SANCHEZ FAMILY CHILD CAREFACILITY NUMBER:
364830976
ADMINISTRATOR:SANCHEZ, PAULAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 455-4861
CITY:ONTARIOSTATE: CAZIP CODE:
91761
CAPACITY:14CENSUS: 2DATE:
10/25/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:47 AM
MET WITH:Paula Sanchez, LicenseeTIME COMPLETED:
09:52 AM
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A case management visit is being conducted in response to the receipt of an Unusual Incident Report (UIR) from the facility. The written UIR was received by the licensing agency on October 14, 2021. It indicates that on October 12, 2021 at 4:45PM while two children were playing in the backyard, the Licensee went inside to get water for the children. While getting water for the children, it spilled. The Licensee began to clean it up and when she looked outside she observed a child exposing himself/herself to another child.

Facility records were reviewed and interview(s) was/were conducted. Based on information gathered, the facility acted appropriately, and no violations have been identified. The Licensee immediately called the children in to talk with them about the incident and separated them until pick up. The Licensee informed both children's parents about the incident and contacted all appropriate agencies. The Licensee notified Licensing within the time frame set forth in Title 22 regulations.

An exit interview was conducted and a copy of this report was provided to the Licensee.

SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Elyse JonesTELEPHONE: (951) 897-2468
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2021
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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