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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334843376
Report Date: 03/10/2025
Date Signed: 03/10/2025 11:23:32 AM

Document Has Been Signed on 03/10/2025 11:23 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:PENALOZA FAMILY CHILD CAREFACILITY NUMBER:
334843376
ADMINISTRATOR/
DIRECTOR:		PENALOZA,KELLY & JAIMEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 818-1254
CITY:CORONASTATE: CAZIP CODE:
92883
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/10/2025
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Kelly Penaloza, LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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On 3/10/2025, at 10:00 AM, an Informal Conference was held at the Riverside Regional Office. Present in the conference were Licensee, Kelly Penaloza, Licensing Program Manager (LPM) Gilbert Sena, and Licensing Program Analyst (LPA) Claudia Caywood.

The Purpose of the meeting was to review and discuss the following:

· Recent deficiencies cited on 12/20/2023, 2/21/2024, and 1/31/2025.
· Safe sleep
· Operation of a FCCH
· Staff/Children Immunizations
· Maintaining ratios
· Licensees’ presence at facility
· Technical Support Program (TSP)

Licensee was advised to visit the Department's website at:
https://cdss.ca.gov/inforesources/child-care-licensing/resources-for-providers

Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensing related information to licensed facilities, visit the CCLD Important Information website at:

https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Childcare option to receive email communication. (CONT. 809-C)

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2025
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: PENALOZA FAMILY CHILD CARE
FACILITY NUMBER: 334843376
VISIT DATE: 03/10/2025
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TSP was discussed with the licensee and was encouraged to voluntarily enroll or seek training from an outside vendor in the areas discussed during this informal conference. The licensee was provided with the following: Forms/Records to Keep in Your FCCH (LIC 311D), CCR 102417 Operation of a FCCH, CCR 102425 Infant Safe Sleep, CCR 102418 Immunizations, CCR 102416.5 Staffing Ratio and Capacity and Health and Safety Code 1597.622.

As a result of this informal conference, Licensee Kelly Penaloza understands the department’s expectations regarding Infant Safe Sleep, operation of a FCCH, immunizations, maintaining ratios, and licensees’ presence at the facility. Licensee agrees to maintain substantial compliance with all Title 22 Regulations. Licensee also understands that not remaining in compliance can lead to additional administrative actions.

LPA Caywood informed Licensee to provide a copy of this licensing report dated 3/10/2025 to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care and to any newly enrolled children's parents/guardians for the next 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2025
LIC809 (FAS) - (06/04)
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