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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300452
Report Date: 03/15/2022
Date Signed: 03/15/2022 10:39:39 AM

Document Has Been Signed on 03/15/2022 10:39 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:SANCHEZ FAMILY CHILD CAREFACILITY NUMBER:
336300452
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 1CENSUS: 0DATE:
03/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Bertha SanchezTIME COMPLETED:
10:47 AM
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Licensing Program Analyst (LPA) Ana Noble arrived to conduct a case management visit to interview a child regarding another facility and not related to this facility. LPA met with Bertha Sanchez, Licensee and informed of purpose of visit and was granted permission into the facility. LPA Noble conducted census and met with child regarding another facility.

An exit interview, was conducted with Licensee Bertha Sanchez, a copy of this report was left with the Bertha Sanchez, Licensee. A copy must be made available upon request, to the public, for 3 years.
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Ana Noble
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2022
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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