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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334830970
Report Date: 12/12/2022
Date Signed: 12/12/2022 02:54:24 PM

Document Has Been Signed on 12/12/2022 02:54 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:RIAD FAMILY CHILD CAREFACILITY NUMBER:
334830970
ADMINISTRATOR:RIAD, AMALFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 318-2351
CITY:CORONASTATE: CAZIP CODE:
92880
CAPACITY: 14TOTAL ENROLLED CHILDREN: 5CENSUS: 4DATE:
12/12/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Amal Riad, Licensee TIME COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elyse Jones arrived at the facility to conduct an inspection for another purpose. During this inspection, census were taken and facility records were reviewed.

During the interview with the Licensee she stated did not have a current facility roster available for review and did not have children's records available for C1, C2, C3 and C5.


See LIC809D for deficiency cited per California Code of Regulations Title 22, Division 12 and Health & Safety Code.

An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Licensee.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 12/12/2022 02:54 PM - It Cannot Be Edited


Created By: Elyse Jones On 12/12/2022 at 02:34 PM
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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: RIAD FAMILY CHILD CARE
FACILITY NUMBER: 334830970

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2022
Section Cited
CCR
102412(a)

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Child's Records 102421(a)
The licensee shall maintain, in each child's record, the signed and dated notice form required in Section 102419(d).
This requirement was not met as evidenced by:
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Licensee agrees to submit required documents to the Department for C1, C2, C3 and C5 on or by the POC due date.
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Based on the interview, the Licensee did not meet the Child’s Records regulation which poses a potential Health, Safety & Personal Rights risk to the children in care. During the interview the Licensee stated she did not have file children’s records for C1, C2, C3 and C5.
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Type B
12/15/2022
Section Cited
CCR102417(g)(8)

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Operation of a Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not be limited to: (8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.
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Licensee agrees to submit a current facility roster to the Department on or by the POC due date.
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This requirement was not met as evidenced by: Based on the interview, the Licensee did not meet the Operation of a Family Child Care Home regulation which poses a potential Health, Safety & Personal Rights risk to the children in care. During the interview the Licensee stated she did not have a current facility roster.
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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:Aaron Ross
LICENSING EVALUATOR NAME:Elyse Jones
LICENSING EVALUATOR SIGNATURE:
DATE: 12/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/12/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2