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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846697
Report Date: 01/29/2025
Date Signed: 01/29/2025 03:06:08 PM

Document Has Been Signed on 01/29/2025 03:06 PM - 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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:PENA-BRISENO FAMILY CHILD CAREFACILITY NUMBER:
334846697
ADMINISTRATOR/
DIRECTOR:		AMBAR PENA-BRISENOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 246-8800
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
92509
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
01/29/2025
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Ambar Pena-BrisenoTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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On 01/29/2025, an Informal Conference was held at the Riverside Regional Office. Present in the conference were Licensee Ambar Pena-Briseno, Licensing Program Manager (LPM) Ana Noble, and Licensing Program Analysts (LPAs) Tiffanie Diep and Susan Brewer.

The purpose of the meeting was to review and discuss the following:
  • Recent deficiencies cited on 11/20/2024, 03/26/2024, and 10/31/2023 while operating the licensed facility Pena-Briseno Family Child Care Home (334845425).
  • 102352(f)(1) Definitions of a Family Child Care Home
  • 102383(a)(1) Term of a License
  • 102417 Operation of a Family Child Care Home
  • 102370 Criminal Record Clearance / Criminal Record Exemptions
  • 102416 Personnel Requirements and 102416.1 Personnel Records
  • 102416.2 Reporting Requirements
  • 102416.5 Staffing Ratio and Capacity
  • 102421 Children Records

Licensee was advised to visit the Department's website at: https://cdss.ca.gov/inforesources/child-care-licensing/resources-for-providers.

Continues on LIC 809-C
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: PENA-BRISENO FAMILY CHILD CARE
FACILITY NUMBER: 334846697
VISIT DATE: 01/29/2025
NARRATIVE
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Continued from LIC 809 (Page 2)

CCLD regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters, and other important information communication platforms. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive e-mail communication.

Technical Support Program (TSP) was discussed with the licensee and Licensee was encouraged to voluntarily enroll or seek training from an outside vendor in the areas discussed during this informal conference. The licensee was provided with the following: TSP brochure, Title 22 Regulations - Forms/Records to Keep in Your FCCH (LIC 311D), 102352(f)(1) Definitions of a Family Child Care Home, 102383(a)(1), 102417 Operation of a Family Child Care Home, 102370 Criminal Record Clearance / Criminal Record Exemptions, 102416 Personnel Requirements and 102416.1 Personnel Records, 102416.2 Reporting Requirements, 102416.5 Staffing Ratio and Capacity, and 102421 Children Records.

Licensee was also encouraged to contact Riverside County Office of Education (RCOE) Resource and Referral Agency for additional resources and training pertaining to Operating a Family Child Care Home.

A link to videos for Family Child Care Providers – California Child Care Licensing – Resources for Parents and Providers can be found on the Community Care Licensing Website - Family Child Care Home, which can be accessed at https://ccld.childcarevideos.org/family-child-care-providers/.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: PENA-BRISENO FAMILY CHILD CARE
FACILITY NUMBER: 334846697
VISIT DATE: 01/29/2025
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Continued from LIC 809-C (Page 3)

As a result of this Informal Conference, Licensee Ambar Pena-Briseno understands the Department’s expectations regarding the Operation of a Family Child Care Home, Term of a License, Criminal Record Clearance / Criminal Record Exemptions, 102416 Personnel Requirements and Records, Reporting Requirements, Staffing Ratio and Capacity, and Children’s Records. The licensee also understands that not remaining in compliance can lead to additional administrative actions.

LPAs Tiffanie Diep and Susan Brewer informed Licensee to provide a copy of this licensing report dated 01/29/2025 to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC809 (FAS) - (06/04)
Page: 3 of 3