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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844851
Report Date: 07/16/2024
Date Signed: 07/16/2024 09:51:54 AM

Document Has Been Signed on 07/16/2024 09:51 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/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 2DATE:
07/16/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:23 AM
MET WITH:Pristine PerezTIME VISIT/
INSPECTION COMPLETED:
10:10 AM
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On 07/16/24, at time listed above, Licensing Program Analyst (LPA) Sumayya Habeebulla arrived at the facility for the purpose of a proof of correction verification from a previous deficiency dated 06/25/24. LPA toured the facility with Licensee. Proof of corrections were made and POC letter will be mailed to the facility.

LPA observed a carbon monoxide detector located on the kitchen counter and it was not mounted on the wall. LPA advised Licensee to mount it on the wall as per the device instruction. The back panel was missing for the device. The device did function and was in working order when tested by Licensee. Licensee mounted the device on to the kitchen wall during the visit.

Based on observations made during today’s visit, the plan of correction has been met. An exit interview was conducted, and a copy of this report was provided.

Notice of site visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2024
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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