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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842112
Report Date: 08/17/2022
Date Signed: 08/17/2022 12:45:48 PM

Document Has Been Signed on 08/17/2022 12:45 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:GARCIA FAMILY CHILD CAREFACILITY NUMBER:
334842112
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
08/17/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Norma Garcia LicenseeTIME COMPLETED:
12:35 PM
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On the above noted date and time Licensing Program Analyst (LPA) Diana Brasel arrived at the facility in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 08/09/2022. It indicates that there was information brought to the licensee's attention. Upon receiving the information the licensee acted appropriately by reporting the information to the appropriate agencies. On this date a tour of the facility was conducted, facility records were reviewed, information was gathered, interviews conducted, and documents obtained.

Based on information gathered, the facility acted appropriately, and no violations have been identified.

An exit interview conducted, and appeal rights were reviewed with the licensee.
A notice of site visit was given and must remain posted for 30 days, failure to comply with posting requirements shall result in an immediate civil penalty of $100.

A copy of this report was provided to the licensee on this date and must be made available to the public upon request for the next 3 years.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Diana Brasel
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2022
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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