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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198021289
Report Date: 12/12/2023
Date Signed: 12/12/2023 09:18:11 AM

Document Has Been Signed on 12/12/2023 09:18 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:ROJAS FAMILY CHILD CAREFACILITY NUMBER:
198021289
ADMINISTRATOR:ROJAS, LORENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 541-7486
CITY:POMONASTATE: CAZIP CODE:
91766
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/12/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Lorena RojasTIME COMPLETED:
09:20 AM
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Pre-Licensing inspection conducted by Licensing Program Analyst Jennifer Hua. LPA met with applicant Lorena Rojas. The purpose of the visit is to follow up on the corrections noted on initial visit report. Applicant stated that her and her husband have moved in. Applicant took LPA on a tour of the home. LPA observed there are some personal items, like clothing, bathroom items, food items in the home. Applicant stated that still waiting to receive her and her spouse's driver license to reflect facility address on the license. LPA also observed a parent board in the day care area, with posted documents: Parent Rights poster, LIC 610A, facility sketch. LPA also observed a crib and napping mats in Bedroom #3 that is use for children.

Prior to licensure, the following shall be received:

1. Copy of the applicant and spouse driver license to reflect facility address. Applicant stated address change was submitted last month on the 16th and the 17th, and was told will take about 3 weeks for her to receive the updated licenses.

An exit interview conducted with applicant, copy of report given.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Jennifer Hua
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2023
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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