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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364840318
Report Date: 11/22/2019
Date Signed: 11/22/2019 12:52:55 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:CALVARY CHAPEL RIALTOFACILITY NUMBER:
364840318
ADMINISTRATOR:RAMIREZ, MAYELYFACILITY TYPE:
850
ADDRESS:1391 W. MERRILLTELEPHONE:
(909) 820-9072
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY:60CENSUS: 25DATE:
11/22/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Mayely RamirezTIME COMPLETED:
01:00 PM
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The Licensing Program Analyst (LPA) arrived at the facility to conduct a Case Management visit to confirm about a rejected fingerprint of the referenced individual listed on (See LIC811). Licensing received a rejected notice dated 11/06/19. The LPA met with the Center Director Ms. Mayely Ramirez and the following was discussed:

The referenced individual submitted for fingerprint twice and still did not go through. Per CBCB Notice, this individual must submit new fingerprints within 30 days of the date notice. If they do not submit new fingerprints, the regional office will be notified, he/she may be removed from the facility and civil penalties may be assessed.
Center director understands the urgency of having to re submit the fingerprint clearance,

An exit interview was conducted, a copy of this report was provided to facility on date and time listed.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Fe FloriaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2019
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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