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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844177
Report Date: 10/03/2023
Date Signed: 10/03/2023 09:26:34 AM

Document Has Been Signed on 10/03/2023 09:26 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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:PINEDA FAMILY CHILD CAREFACILITY NUMBER:
334844177
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
10/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Eva PinedaTIME COMPLETED:
09:30 AM
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On date and time listed, Licensing Program Analyst (LPA) William Chancellor arrived at the facility unannounced to conduct a Case Management visit to follow up on progress of fire inspection clearance and required visits by the department.

Upon arrival, LPA stated the reason for the visit and took census. Six (6) children were present, including two infants. Appropriate ratios and capacity's were being followed with only licensee present. LPA also toured the home and spoke with licensee about the progress of the fire inspection clearance.

Licensee stated that an inspection is pending from the Fire Marshall. LPA shared that they will return at a future date, unannounced once fire clearance is received to the department and or for required visits.

An exit interview was conducted and a copy of this report was provided to licensee, Eva Pineda. A notice of site visit was given and must remained posted for 30 days.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: William M Chancellor Jr.
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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