<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845087
Report Date: 06/12/2024
Date Signed: 06/12/2024 10:01:29 AM

Document Has Been Signed on 06/12/2024 10:01 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:FLORES FAMILY CHILD CAREFACILITY NUMBER:
334845087
ADMINISTRATOR/
DIRECTOR:		FLORES,MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(619) 715-2947
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY: 14TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
06/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Maria FloresTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Sumayya Habeebulla arrived at the facility to conduct an inspection, for a separate an unrelated issue on the date and time listed above. LPA met with Licensee Maria Flores and discussed the reason for the visit. During the review of the facility files, it was observed by LPA that Licensee had not updated the facility roster and were missing the names and details of a total of 8 children 3 of whom were in attendance during today's visit. LPA advised Licensee to update the facility roster during this visit.

The facility was cited: Health and Safety Code Section 1596.841:



Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, and the name and telephone number of the child's physician. This roster shall be available to the licensing agency upon request.

An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to the Licensee Ms. Maria Flores.



A copy of this report must be made available to the public, upon their request, for 3 years.

The Notice of Site Visit must be posted for 30 days.

Failure to keep these posted for the entire 30 days will result in an immediate $100 civil penalty for each day.

The Licensee can submit transfer forms to associate new individuals or to disassociate at: Associations_Disassociations862@dss.ca.gov

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 06/12/2024 10:01 AM - It Cannot Be Edited


Created By: Sumayya Habeebulla On 06/12/2024 at 09:30 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: FLORES FAMILY CHILD CARE
FACILITY NUMBER: 334845087

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/12/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/14/2024
Section Cited
HSC
1596.841

1
2
3
4
5
6
7
Each child day care facility shall maintain a current roster of children who are provided care in the facility. The roster shall include the name, address, and daytime telephone number of the child's parent or guardian, ... This roster shall be available to the licensing agency upon request.
1
2
3
4
5
6
7
Licensee agrees to update teh facility roster and maintain teh update anytime a child is enrolled or dienrolls the facility. Licensee submitted a statement during LPA's visit and updated teh roster during the visit.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:
Based on observation during the file reviews LPA observed the facility roster had not been updated and was missing the names and details of 9 children who were or are currently enrolled at the child care facilty.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Carlos Martinez
LICENSING EVALUATOR NAME:Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2