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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376623793
Report Date: 06/18/2019
Date Signed: 06/18/2019 03:43:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:RAVEN, TIFFANIE FAMILY CHILD CAREFACILITY NUMBER:
376623793
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
06/18/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Tiffanie RavenTIME COMPLETED:
04:00 PM
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Licensing Program Analysts (LPA) Samantha Salunga and Leilani Curtis completed an unannounced case management inspection for the purpose of following-up on a cross-reported incident involving Licensee's foster children. Licensee is dually licensed. Licensee is caring for day care children in addition to her foster care children. Upon arrival, LPAs met with Licensee and proceeded to tour the facility. Also present was LPA Gloria Meza from Children’s Residential. LPA Gloria Meza conducted an interview with Licensee and a foster child. Also present were 5 children (3 preschoolers, 1 infant, and 1 school-age). Appropriate ratio and capacity was observed.

No deficiencies observed in the areas inspected during today's inspection. LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS. Due to printer malfunction, LPA Salunga will email and mail a copy of the NOS to Licensee. Licensee states she will provide LPA Salunga with a photo of the NOS posted. LPAs reviewed this report with Licensee prior to obtaining her signature below.

Access our updated Regulation & Forms by using our WEBSITE: http://ccld.ca.gov
SUPERVISOR'S NAME: Monica CuddyTELEPHONE: (619) 767-2249
LICENSING EVALUATOR NAME: Samantha SalungaTELEPHONE: (619) 767-2209
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2019
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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