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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334805633
Report Date: 11/14/2023
Date Signed: 11/14/2023 01:18:35 PM

Document Has Been Signed on 11/14/2023 01:18 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:TOMLINSON FAMILY CHILD CAREFACILITY NUMBER:
334805633
ADMINISTRATOR:TOMLINSON, SUSANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 778-0862
CITY:RIVERSIDESTATE: CAZIP CODE:
92507
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
11/14/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:59 PM
MET WITH:Licensee Susan TomlinsonTIME COMPLETED:
01:30 PM
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On 11-14-2023 and time listed above, Licensing Program Analyst (LPA) Steven Montoya arrived at the facility to conduct an CM deficiency inspection. Licensee was caring for 2 children at the time of the visit. LPA was granted entry by Licensee, Susan Tomlinson.LPA toured the facility, inside and out, reviewed records, and observed and/or discussed the following: Mandated reporting certificate needed to completed POC.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2023
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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