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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304312509
Report Date: 01/17/2025
Date Signed: 01/17/2025 03:36:23 PM

Document Has Been Signed on 01/17/2025 03:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY CC RO, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:RIOS, BELINAFACILITY NUMBER:
304312509
ADMINISTRATOR/
DIRECTOR:		RIOS, BELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 499-7415
CITY:BUENA PARKSTATE: CAZIP CODE:
90621
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
01/17/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:17 PM
MET WITH:Belina RiosTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On 1/17/2025, Licensing Program Analysts (LPAs) Silva conducted an announced Case Management – Other. The LPA met with licensee Belina Rios who was informed of the purpose of the visit. A review of the Facility Personnel Report Summary all personnel who was present have clearance. Census was 7 children.

During the visit, the LPA conducted children interviews and staff interviews.

An exit interview was conducted. Appeal rights were reviewed and provided. The notice of site visit was posted.
SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Archibaldo Silva
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
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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