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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300438
Report Date: 04/25/2023
Date Signed: 04/25/2023 02:33:56 PM

Document Has Been Signed on 04/25/2023 02:33 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:LOYOLA&MEDINA FAMILY CHILD CAREFACILITY NUMBER:
336300438
ADMINISTRATOR:LOYOLA,PAOLA&MENDINA,BLANCFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(805) 509-8249
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 5DATE:
04/25/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Paola LouolaTIME COMPLETED:
02:40 PM
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On date and time listed, Licensing Program Analyst (LPA) Sumayya Habeebulla conducted a case management for an Unusual Incident Report (UIR) that was received by the Department on 04/18/23.

The UIR stated that Licensee suffered a stroke during childcare hours and was taken to the Hospital in an ambulance. Licensee stated she returned home on 04/09/23. Licensee feels much better now and has resumed childcare activities. During her absence, her Co-Licensee Ms. Blanca Medina took care of the children.

An exit interview was conducted, and this report was reviewed with the licensee Paola Loyola. Appeal rights were discussed and provided during the exit interview.



A notice of site visit was given and must remain posted for 30 days
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2023
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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