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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842112
Report Date: 05/21/2024
Date Signed: 05/21/2024 10:37:58 AM

Document Has Been Signed on 05/21/2024 10:37 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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GARCIA FAMILY CHILD CAREFACILITY NUMBER:
334842112
ADMINISTRATOR/
DIRECTOR:		GARCIA, NORMA/GARCIA, JOSEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 838-6415
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
05/21/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:11 AM
MET WITH:Co-Licensee Norma GarciaTIME VISIT/
INSPECTION COMPLETED:
10:50 AM
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On the date and time listed, Licensing Program Analysts (LPA) Perla Ordones and Giselle Carbullido conducted an unannounced case management visit to follow up on a Confirmation of Removal for Nicholas Garcia. LPAs were greeted by Co-Licensee Norma Garcia and granted entry into the facility. Present during this visit were: Co-licensee Norma Garcia, assistant Lourdes Aleman, and co-licensees adult child Damian Garcia.

LPAs explained the purpose of the visit and explained the written Confirmation of Removal for Nicholas Garcia. The co-licensee, Norma Garcia, stated that Nicholas Garcia is their son and no longer resides in the home as of 05/20/2024. Per the co-licensee, Norma Garcia signed the Confirmation of Removal on 05/20/2024, following receipt of the notification. Co-licensee provided a copy of the signed Confirmation of Removal and a photo was taken by LPAs. During the inspection, the co-licensee completed the LIC279A Application form to confirm current adults living in the home.

The co-licensee was provided a copy of the Exemption Denial and Confirmation of Removal for Nicholas Garcia from all facilities. The co-licensee was provided a copy of Addendum to Notification of Parent’s Rights (LIC 995B) which is to be signed by each child’s parent or guardian, a copy is to be provided to each child’s parent or guardian, and the original placed in each child’s file. Co-licensee stated they understands that failure to have form LIC 995B signed by parent/guardian, failure to provide a copy to the parent/guardian, and failure to have original form placed in each child’s file could result in a civil penalty of $100.00 per family.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Perla Ordones
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: GARCIA FAMILY CHILD CARE
FACILITY NUMBER: 334842112
VISIT DATE: 05/21/2024
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Based on evidence obtained during today’s inspection, the LPAs have verified that Nicholas Garcia was not present during today’s visit however belongings of Nicholas Garcia were still present at the facility. Co-licensee Norma Garcia stated that they will be packaging the items to give to their owner and would send photos to LPAs once all belongings have been removed. Co-licensee also signed a written statement wherein they stated that Nicholas Garcia no longer lives at the facility and resides at a new stated address.

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.

During the exit interview, the CO-LICENSEE Norma Garcia confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the co-licensee Norma Garcia.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Perla Ordones
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC809 (FAS) - (06/04)
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