334846979-7-17-2026-09-CC-PORZ-DW3UBE-20260717152613

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 334846979
Report Date: 07/17/2026
Date Signed: 07/17/2026 03:26:31 PM

Document Has Been Signed on 07/17/2026 03:26 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:	CHAVEZ FAMILY CHILD CARE		FACILITY NUMBER:	334846979
ADMINISTRATOR/ DIRECTOR:			FACILITY TYPE:	810
ADDRESS:			TELEPHONE:
CITY:		STATE:	ZIP CODE:
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 4	CENSUS: 1	DATE:	07/17/2026
TYPE OF VISIT:	Case Management - Licensee Initiated	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Licensee Maria Chavez		TIME VISIT/ INSPECTION COMPLETED:	03:35 PM

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	On date and time listed, Licensing Program Analyst (LPA) Perla Ordonez arrived at the facility to conduct a Case Management visit for the purpose of a capacity increase. LPA toured the facility, inside and out, and the following was observed and/or discussed: Normal days and hours of operation are: Monday – Saturday; 04:00AM – 12:30PM. OFF-LIMIT AREAS INCLUDE: Room 1, Room 2, Room 3, Backyard, and Garage. The facility is operating within the licensed capacity and appropriate ratios. · Appropriate supervision provided during this inspection. · A working telephone is present and current number on file. · Appropriate fire extinguisher, smoke detector and carbon monoxide detector present and were tested by the Licensee during this inspection. · All hazardous items are not stored inaccessible to children. During facility tour, LPA observed hazards such as construction equipment and supplies in the Backyard were accessible. · Toxins are locked. · Weapons are not present per Licensee Maria Chavez. Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations. · This is a one story home.

NAME OF LICENSING PROGRAM MANAGER: Aaron Ross
NAME OF LICENSING PROGRAM ANALYST: Perla Ordonez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 334846979
	VISIT DATE: 07/17/2026

NARRATIVE

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· Verification of control of property on file.
· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted.
· Mandated Reporter Child Care Providers Training expires on 07/17/2028.
· Pediatric CPR and First Aid Card expired on 07/15/2026.
· Health & Safety Certificate – completed on 06/26/2022.
· No bodies of water at this time. Licensee understands all bodies of water including ponds, above ground pools & spas, in-ground pools & spas, and some fountains must be properly covered or fenced per Title 22 Regulations. The Department must be notified before and after installation of the above types of bodies of water. In addition, all wading pools or similar product must be emptied immediately after use and stored in an upright position.
· Clean, safe and age appropriate toys.
· Fire Clearance granted on 06/25/2026.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22- 02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514- 0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

NAME OF LICENSING PROGRAM MANAGER: Aaron Ross
NAME OF LICENSING PROGRAM ANALYST: Perla Ordonez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026

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: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 334846979
	VISIT DATE: 07/17/2026

NARRATIVE

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Before licensure, the following needs to be corrected/completed:
- The Plan of Corrections for all the deficiencies cited during today’s visit must be submitted and cleared.

Once all corrections have been verified, the application for a Large Family Child Care Home will be submitted for approval with a maximum capacity of 12 or 14 with parent notification/assistant present. Applicant advised that all corrections must be submitted by the Plan of Correction due dates or the application may be withdrawn.

See LIC809-D for cited deficiencies.

A notice of site visit was given to licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.
Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

During the exit interview, the Licensee Maria Chavez, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the Licensee Maria Chavez.

NAME OF LICENSING PROGRAM MANAGER: Aaron Ross
NAME OF LICENSING PROGRAM ANALYST: Perla Ordonez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/17/2026 03:26 PM - It Cannot Be Edited

Created By: Perla Ordonez On 07/17/2026 at 02:58 PM

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 ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: CHAVEZ FAMILY CHILD CARE	FACILITY NUMBER: 334846979
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/17/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/31/2026 Section Cited CCR 102416(c)	1 2 3 4 5 6 7	(c) The licensee and other personnel as specified shall complete training on preventive health practices, including pediatric cardiopulmonary resuscitation and pediatric first aid, pursuant to Health and Safety Code Section 1596.866. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to obtain a current EMSA approved/pediatric CPR/1st Aid certificate. Licensee agrees to send proof of the Plan of Correction (POC) to Community Care Licensing (CCL) by the end of the business day on the POC due date of 07/31/2026.
	8 9 10 11 12 13 14	Based on interview and record review, the licensee did not comply with the section cited above as LPA observed that Licensee's CPR/1st Aid certificate expired on 07/15/2026 which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
Type B 07/31/2026 Section Cited CCR102417(g)(4)	1 2 3 4 5 6 7	(4) Poisons, detergents, cleaning compounds, medicines, firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to purchase a door lock to make the Backyard inaccessible. Licensee agrees to send proof of the Plan of Correction (POC) to Community Care Licensing (CCL) by the end of the business day on the POC due date of 07/31/2026.
	8 9 10 11 12 13 14	Based on observation and interview, the licensee did not comply with the section cited above as LPA observed that hazards such as construction equipment and supplies in the Backyard were accessible which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Aaron Ross
NAME OF LICENSING PROGRAM MANAGER:

	Perla Ordonez
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/17/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2026

LIC809 (FAS) - (06/04)

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