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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330927502
Report Date: 04/18/2024
Date Signed: 04/18/2024 10:51:05 AM

Document Has Been Signed on 04/18/2024 10:51 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:DIAZ FAMILY DAY CAREFACILITY NUMBER:
330927502
ADMINISTRATOR/
DIRECTOR:		DIAZ, YFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 924-4846
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 1DATE:
04/18/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:29 AM
MET WITH:Ying Diaz, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced subsequent complaint visit to the facility. LPA met with Licensee Ying Diaz and informed them of the purpose of this visit.

While conducting an investigation into complaint #10-CC-20240402130734, Licensee revealed that they allowed Child One (C1) to sleep in a car seat that was placed in a stroller. This is a violation of Title 22, and thus, a citation was issued.

An exit interview was conducted where a copy of this report was provided along with a copy of the LIC811, LIC809D, and Appeal Rights.

A Notice of Site visit was given, and the Licensee understands that it must remain posted for 30 days.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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Document Has Been Signed on 04/18/2024 10:51 AM - It Cannot Be Edited


Created By: Jesse Gardner On 04/18/2024 at 10:33 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: DIAZ FAMILY DAY CARE
FACILITY NUMBER: 330927502

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/25/2024
Section Cited
CCR
102425(h)

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Infant Safe Sleep:
(h) Car seats shall only be used for transportation purposes and shall not be used for sleeping. This requirement was not being met as evidenced by:
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Licensee states that they will conduct in-service training and provide proof of such to LPA by POC date.
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Based on interview with Licensee, C1 was allowed to remain asleep in a car seat instead of transferring to a crib. This poses a potential health and safety or personal rights risk to children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Deborah Mullen
LICENSING EVALUATOR NAME:Jesse Gardner
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024


LIC809 (FAS) - (06/04)
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