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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300474
Report Date: 04/27/2022
Date Signed: 04/27/2022 09:44:25 AM

Document Has Been Signed on 04/27/2022 09:44 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:VICTOR FAMILY CHILD CAREFACILITY NUMBER:
336300474
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
04/27/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Consuelo VictorTIME COMPLETED:
09:50 AM
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On the date and time listed, Licensing Program Analyst (LPAs) Sumayya Habeebulla and Jessica Rubio arrived at the facility to conduct a subsequent pre-licensing inspection. A physical plant inspection was conducted to ensure the plan of corrections were met prior to licensure.


The following was observed:

1. Stairs are barricaded - LPA will discuss with LPM if the barricade is appropriate
2. Backyard - all items that need to be out of reach of children have been removed
3. Backyard - right side of the house has been gated to prohibit access to children
4. Pool has been fenced with a 5-foot gated fence as per Title 22 regulation
5. Items present in the Living Room - Mirror, Picture Frames have been removed/mounted
6. Child Safety locks on the Dining Room Cabinet
7. Restroom that will be used by day care children drawer and cabinets are locked
8. Electric Outlets are Covered
9. Fire Extinguisher - 2A:10BC
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2022
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: VICTOR FAMILY CHILD CARE
FACILITY NUMBER: 336300474
VISIT DATE: 04/27/2022
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All corrections have been sight verified by LPAs Sumayya Habeebulla and Jessica Rubio, and the application for a Small Family Child Care Home will be submitted for approval with a maximum capacity of 6, or 8 with parent notification.


During the exit interview, the Applicant Consuelo Victor, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

An Exit interview was conducted, and the report was reviewed with the Applicant - Consuelo Victor

A copy of this report was left with the Applicant and a copy must be made available upon request, to the public, for 3 years.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2022
LIC809 (FAS) - (06/04)
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