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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330910696
Report Date: 05/13/2022
Date Signed: 05/13/2022 12:12:23 PM

Document Has Been Signed on 05/13/2022 12:12 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:ENRIQUEZ CARE FACILITYFACILITY NUMBER:
330910696
ADMINISTRATOR:NUBIA ENRIQUEZFACILITY TYPE:
735
ADDRESS:256 SOUTHSHORE DRIVETELEPHONE:
(951) 743-2818
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY: 6CENSUS: 3DATE:
05/13/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:59 AM
MET WITH:Nubia Enriquez and Jesse EnriquezTIME COMPLETED:
12:15 PM
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LIcensing Program Analyst (LPA) Jennifer Semin met with Licensee/administrator Nubia Enriquez and Jesse Enriquez in the San Bernardino Regional Office to discuss annual fees, late payments and the facility annual fee transaction history.

Mr and Mrs Enriquez presented copies of various bank statements, cancelled checks and copies of money orders for 2005, 2006, 2009, 2010, 2011, 2012, 2013, 2015, 2016, 2017, 2018, 2020 and 2021. LPA and Mr and Mrs Enriquez discussed line by line the transaction history and cross-referenced this with the documents they presented.

LPA discussed the findings with LPM Clemons and requested all documents be scanned and sent along with an email to Sacramento main office. LPA will be in touch with Mr and Mrs Enriquez once information is available.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Jennifer Semin
LICENSING EVALUATOR SIGNATURE: DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/13/2022
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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