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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330910505
Report Date: 04/19/2022
Date Signed: 04/19/2022 10:58:40 AM


Document Has Been Signed on 04/19/2022 10:58 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:CHILDTIME CHILDREN'S CENTERFACILITY NUMBER:
330910505
ADMINISTRATOR:SURIATI C. CAFAROFACILITY TYPE:
850
ADDRESS:14700 PERRIS BLVD.TELEPHONE:
(951) 242-0707
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:73CENSUS: 36DATE:
04/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Suri CafaroTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Rachel Zeron arrived at the facility on a Case Management to provide an amended report for complaint control #10-CC-20211230091426 . LPA toured the facility and took census. LPA met with Director Suri Cafaro to review the amended report and report was signed and Director was given a copy to replace the original report.

An exit interview was conducted, and this report was reviewed with the Director Suri Cafaro.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Rachel ZeronTELEPHONE: (951) 782-4207
LICENSING EVALUATOR SIGNATURE:
DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/19/2022
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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