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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846056
Report Date: 08/05/2022
Date Signed: 08/05/2022 09:52:01 AM

Document Has Been Signed on 08/05/2022 09:52 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:MEDRANO FAMILY CHILD CAREFACILITY NUMBER:
334846056
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
08/05/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Amanda MedranoTIME COMPLETED:
09:55 AM
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 LPA Aman Sharma and LPM Kimberly Williams conducted a case management inspection at the facility on this date to amend the Facility Complaint Report dated 07/28/2022.  LPA and LPM met with licensee Amanda Medrano and reviewed the amended report during this inspection.

Exit interview was conducted with the licensee.  A copy of this report, the amended report and Proof Of Correction (POC) letter, dated 08/02/2022 were provided to the licensee.

This report must be made available at the facility for 3 years for public review upon request.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE: DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/05/2022
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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