<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
336300177
Report Date:
11/12/2021
Date Signed:
11/16/2021 08:41:00 AM
Document Has Been Signed on
11/16/2021 08:41 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:
IBARRA FAMILY CHILD CARE
FACILITY NUMBER:
336300177
ADMINISTRATOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
TOTAL ENROLLED CHILDREN:
8
CENSUS:
DATE:
11/12/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
12:35 PM
MET WITH:
Attempted - Licensee Sabreena Ibarra
TIME COMPLETED:
12:50 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
Licensing Program Analyst (LPA) Sumayya Habeebulla arrived at the facility to conduct a required annual inspection on 11/12/21 at the time listed. As LPA exited her vehicle Ms. Ibarra was in her car preparing to leave for her Doctor's appointment. Ms. Ibarra stated she needed to get to her appointment and if we could reschedule the annual visit. LPA inquired if there are any children in care at this time and she replied no. LPA also reminded Ms. Ibarra that her Licensing fees are due and needed to be paid immediately so that late fees do not incur. LPA shared the PIN # for Licensee to make the payment online. Licensee inquired about capacity increase for her facility. LPA provided information on how to proceed with the application for capacity increase. Conversation ended and Licensee drove off.
SUPERVISORS NAME
:
Carlos Martinez
LICENSING EVALUATOR NAME
:
Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE
:
DATE:
11/16/2021
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
11/16/2021
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
1