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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364843726
Report Date: 09/17/2021
Date Signed: 09/17/2021 01:31:54 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:ARGUMEDO FAMILY CHILD CAREFACILITY NUMBER:
364843726
ADMINISTRATOR:ARGUMEDO, LAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 947-4913
CITY:ONTARIOSTATE: CAZIP CODE:
91761
CAPACITY:14CENSUS: 9DATE:
09/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Laura ArgumedoTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Rachel Zeron made an unannounced visit for the purpose of amending report dated 08/04/2021 for complaint #09-CC-20210629094116. LPA toured the facility and took census, no violations were noted LPA went over the amended report with the Licensee. Licensee returned the original report and signed the amended report.
LPA provided a copy of the amended report to the Licensee and conducted an exit interview.
A Notice if Site visit was given, and it was explained by LPA that the notice must be posted for the next 30 days
SUPERVISOR'S NAME: Kimberly WilliamsTELEPHONE: (951) 782-4200
LICENSING EVALUATOR NAME: Rachel ZeronTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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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