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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844851
Report Date: 03/14/2023
Date Signed: 03/14/2023 09:11:11 AM

Document Has Been Signed on 03/14/2023 09:11 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
334844851
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: DATE:
03/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:37 AM
MET WITH:TIME COMPLETED:
09:25 AM
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Licensing Program Analyst (LPA) Sumayya Habeebulla conducted a Case Management visit at the facility on this date to follow up on Confirmation of Removal for Licensee Pristine Perez. The Confirmation of Removal was issued to the facility on 11/18/2022. LPA met with Licensee Pristine Perez and explained the reason for the premise visit. LPA toured the facility; there were no children in care.

During the visit, LPA reviewed the Exemption Denial with Licensee Pristine Perez, and a copy of the document was provided. Based on evidence obtained during today’s visit, the LPA has verified the licensee has ceased all daycare operations effective March 10th, 2023, and has submitted a written request to go on inactive from 03/10/2023. The licensee understands that she cannot continue to operate the daycare and/or provide any type of service until a criminal record exemption is granted.

An exit interview was conducted, and a Notice of Site Visit posted. A copy of this report was provided to the Licensee Pristine Perez on this date.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2023
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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