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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314016
Report Date: 06/15/2022
Date Signed: 06/15/2022 01:57:17 PM

Document Has Been Signed on 06/15/2022 01:57 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
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:TERRONES, LORENAFACILITY NUMBER:
304314016
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
06/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee Ms. Terrones, Lorena TIME COMPLETED:
02:15 PM
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Licensing Program Analyst conducted an unannounced Case Management inspection at the Family Child care home to obtain additional information from the Licensor, present at the home.

LPA met with Ms. Terrones, Lorena present in the home with her children. LPA walked through the home, it remains clean and appropriate for family child care home activities.
Currently there were no enrolled children present in the home.
Home was toured by the LPA.
No other individuals were present at the home.

Notice of site and appeal rights were presented to the Licensee.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Ketki Desai
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2022
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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