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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334810456
Report Date: 10/03/2023
Date Signed: 10/03/2023 02:10:16 PM

Document Has Been Signed on 10/03/2023 02:10 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:VELASCO FAMILY CHILD CAREFACILITY NUMBER:
334810456
ADMINISTRATOR:VELASCO, JUANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 361-3146
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
10/03/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Juana VelascoTIME COMPLETED:
02:20 PM
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On 10/03/2023 Licensing Program Analyst (LPA) Raymond Moorehead and Licensing Program (LPM) Aaron Ross arrived at the facility to conduct a Plan of Correction (POC) visit to follow up on deficiencies cited during the annual inspection that was conducted on 08/29/2023.

LPA confirmed during today's visit that the following deficiencies were corrected:

1.) All enrolled children’s immunization records - Licensee provided documentation of immunizations for the children in care


2.) Facility Roster - LPA reviewed updated facility roster


3.) Proof of C1’s completed file - Licensee provided proof of C1's completed file



Exit interview was conducted with Licensee, a copy of this report has been reviewed and provided with the licensee. Appeal rights were discussed and given. A notice of site visit was given and must remain posted in a prominent place for 30 consecutive days. Failure to comply with posting requirements will result in a civil penalty of $100.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Raymond Moorehead
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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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