<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364813844
Report Date: 05/02/2024
Date Signed: 05/02/2024 03:28:30 PM

Document Has Been Signed on 05/02/2024 03:28 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:RUIZ FAMILY CHILD CAREFACILITY NUMBER:
364813844
ADMINISTRATOR/
DIRECTOR:		NORMA & JOSE RUIZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 609-6549
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY: 14TOTAL ENROLLED CHILDREN: 13CENSUS: 4DATE:
05/02/2024
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Norma Ruiz, Licensee and Jose Luis Ruiz, Co-LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:45 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) Taityana Benson arrived at the facility to conduct a required/annual inspection as part of a compliance review. LPA toured the facility, inside and out, records were reviewed, and the following was observed and/or discussed:
Normal days and hours of operation are: Monday – Friday 6:00 a.m. – 6:00 p.m.

OFF-LIMIT AREAS INCLUDE: All Bedrooms, Master Bathroom, Garage and Both Exterior Sides of the Home.

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, the smoke detector is not functioning.
· Fire Clearance Granted 09/26/2005
· Fireplace is properly screened to prevent access by children
· All hazardous items are not stored inaccessible to children
· Toxins are locked
· Weapons are not present according to Licensee, Norma Ruiz and Co-Licensee, Jose Luis Ruiz. Licensee and Co-Licensee understands all guns, weapons and ammunition must be key locked separately and made inaccessible per Title 22 Regulations
· Single Story Residence
· Verification of control of property viewed at visit (Mortgage Statement)
· Facility Sketch, Emergency Disaster Plan & Notification of Parent’s Rights poster are posted

Report Continued On LIC809-C

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE: DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/02/2024
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 10
Document Has Been Signed on 05/02/2024 03:28 PM - It Cannot Be Edited


Created By: Taityana Benson On 05/02/2024 at 12:21 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: RUIZ FAMILY CHILD CARE
FACILITY NUMBER: 364813844

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
102417(g)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, the licensee and co-licensee did not comply with the section cited above. During the visit, LPA the outdoor play equipment in the backyard with screws protruding from the upper slide, 5 unlocked sheds located in the backyard with miscellaneous items in each shed including shed 4 with tools, and shed 5 with lawn equipment/lawn mower, in which poses an immediate health, safety risk to persons in care.
POC Due Date: 05/03/2024
Plan of Correction
1
2
3
4
Licensee and Co-Licensee agrees to update the exterior facility sketch to include the 5 sheds, place a lock on each shed, and repair the protruding screws in the play equipment/slide in the backyard by 05/03/2024 and prior to allowing children access to the backyard. Licensee and Co-Licensee agrees to provide LPA with proof of all 5 exterior sheds locked, updated exterior facility sketch, and repaired play equipment/slide via email by COB on 05/03/2024.
Type A
Section Cited
CCR
102417(g)(1)
Operation of A Family Child Care Home
(g) The home shall be free from defects or conditions which might endanger a child. Safety precautions shall include but not limited to: (1) Fireplaces and open face heaters shall be screened to prevent access by children. The home shall contain a fire extinguisher and smoke detector device which meet standards established by the State Fire Marshall.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA observation, the licensee and co-licensee did not comply with the section cited above, the co-licensee attempted to test the smoke detector in the hallway and the smoke detector device is not functioning and could not be tested, which poses an immediate health, safety risk to persons in care.
POC Due Date: 05/03/2024
Plan of Correction
1
2
3
4
Licensee and Co-Licensee agrees to restore or replace the smoke detector device to ensure the smoke detector is functioning and operable. Licensee and Co-Licensee agrees to provide LPA with proof of an operable smoke detector via email by COB on 05/03/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Taityana Benson
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024


LIC809 (FAS) - (06/04)
Page: 2 of 10
Document Has Been Signed on 05/02/2024 03:28 PM - It Cannot Be Edited


Created By: Taityana Benson On 05/02/2024 at 12:21 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: RUIZ FAMILY CHILD CARE
FACILITY NUMBER: 364813844

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1596.871(c)(1)(A)
Administration of Child Day Care Licensing
Subsequent to initial licensure, a person specified in subdivision (b) who is not exempt from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification, pursuant to subdivision(f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee and co-licensee did not comply with the section cited above. Prior to S3 employment, S3 did not obtain a eligible criminal record clearance, the criminal record clearance remains in pending/process status, which poses an immediate health, safety risk to persons in care.
POC Due Date: 05/03/2024
Plan of Correction
1
2
3
4
Licensee and Co-Licensee agrees to have S3 re-fingerprint and obtain proof of re-fingerprinting by 05/03/2024 and provide a copy via email to LPA by COB 05/03/2024. Licensee and Co-Licensee agrees to write a statement that S3 will not return to the facility to work until they have proof of an eligible criminal record clearance and verify the eligible criminal record clearance with LPA.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Taityana Benson
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024


LIC809 (FAS) - (06/04)
Page: 3 of 10
Document Has Been Signed on 05/02/2024 03:28 PM - It Cannot Be Edited


Created By: Taityana Benson On 05/02/2024 at 12:21 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: RUIZ FAMILY CHILD CARE
FACILITY NUMBER: 364813844

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee and co-licensee did not comply with the section cited above, S1 Mandated Reporter Training - Child Care Providers (AB1207) was expired on 02/16/2023 and S2 expired on 02/25/2023. There is not a current mandated reporter certificate on file for S1 and S2, which poses a potential health, safety risk to persons in care.
POC Due Date: 05/16/2024
Plan of Correction
1
2
3
4
Licensee and Co-Licensee agrees to have S1 and S2 complete the Mandated Reporter Training - Child Care Providers (AB1207) and provide proof of completion to LPA via email by COB 05/16/2024.
www.mandatedreporterca.com
Type B
Section Cited
CCR
102416(c)
Personnel Requirements
(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:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above, S1 Pediatric CPR/First Aid completed: 02/26/2021 and S2 Pediatric CPR/First Aid completed 03/22/2023, are not EMSA approved Pediatric CPR/First Aid, which poses a potential safety risk to persons in care
POC Due Date: 05/16/2024
Plan of Correction
1
2
3
4
Licensee and Co-Licensee agrees to have S1 and S2 enroll or complete Pediatric CPR/First Aid Training with American Heart Association, American Red Cross, or Emergency Medical Services Authority (EMSA) approved vendor and provide proof of enrollment or completion to LPA via email by COB 05/16/2024.
www.emsa.ca.gov
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Taityana Benson
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024


LIC809 (FAS) - (06/04)
Page: 4 of 10
Document Has Been Signed on 05/02/2024 03:28 PM - It Cannot Be Edited


Created By: Taityana Benson On 05/02/2024 at 12:21 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: RUIZ FAMILY CHILD CARE
FACILITY NUMBER: 364813844

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102416.1(d)
Personnel Records
(d) All personnel records shall be maintained at the child care home and shall be available to the licensing agency for review.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee and co-licensee did not comply with the section cited above, LPA did observe S3 and S4 employee file/records, which poses a potential safety risk to persons in care.
POC Due Date: 05/16/2024
Plan of Correction
1
2
3
4
Licensee and Co-Licensee agrees to establish a complete personnel record/File for S3 and S4 with all the required doucments for employee's and provide LPA with a copy of S3 and S4 file by COB on 05/16/2024.
Type B
Section Cited
HSC
1597.622(a)(1)
General Provisions and Definitions
(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based record review, the licensee and co-licensee did not comply with the section cited above, S1immunization record, including Tuberclious, Influenza Vaccination or Influenza Declination is not on file nor available for view, S2 Pertussis, and Influenza Vaccination or Influenza Declination is not on file nor available for view, which poses potential health risk to persons in care.
POC Due Date: 05/16/2024
Plan of Correction
1
2
3
4
Licensee and Co-Licensee agrees to obtain S1 immunization's records including, Tuberclious, and Influenza Vaccination or Influenza Declination and S2 Pertussis, Tuberclious, and Influenza Vaccination or Influenza and provide a copy via email by COB on 05/16/2024.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Taityana Benson
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024


LIC809 (FAS) - (06/04)
Page: 5 of 10
Document Has Been Signed on 05/02/2024 03:28 PM - It Cannot Be Edited


Created By: Taityana Benson On 05/02/2024 at 12:21 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: RUIZ FAMILY CHILD CARE
FACILITY NUMBER: 364813844

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/02/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102417(g)(8)
Operation of A Family Child Care Home
(8) Each family child care home shall have a current roster of children as specified in Health and Safety Code Section 1596.841.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee and co-licensee did not comply with the section cited above, there is not a current and complete Child Care Facility Roster (LIC9040) on file, which poses a potential safety risk to persons in care.
POC Due Date: 05/16/2024
Plan of Correction
1
2
3
4
Licensee and Co-Licensee agrees to update, complete, and maintain the Child Care Facility Roster (LIC9040) and provide LPA with a copy by COB on 05/16/2024.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kimberly Williams
LICENSING EVALUATOR NAME:Taityana Benson
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024


LIC809 (FAS) - (06/04)
Page: 6 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: RUIZ FAMILY CHILD CARE
FACILITY NUMBER: 364813844
VISIT DATE: 05/02/2024
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
26
27
28
29
30
31
32
·Mandated Reporter Training expired on 02/16/2023 Licensee and 02/25/2023 Co-Licensee
· (Not EMSA Approved Vendor) Pediatric CPR and First Aid Card for Licensee completed 02/26/2021 and Co-Licensee completed on 03/22/2023.
· Health & Safety Certificate - completed on 07/26/2023 Licensee and Co-Licensee
· 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
· Current roster not on file
· Documentation of fire and disaster drills on file – Last drill conducted on 01/18/2024
· Children’s records are not complete
· Employee’s records are not complete
· The Licensee and Co-Licensee was informed of their reporting requirements and is provided with the Regional Office’s Unusual Incident Reporting email mailbox: UnusualIncidentReportsDO09@dss.ca.gov

· Resident and/or staff records reviewed on 05/02/2024 indicate that all adults who require caregiver background checks have received all required clearances or exemptions.

· The Licensee can submit transfer forms to associate new individuals or to disassociate someone from your facility at: Associations_Disassociations862@dss.ca.gov

- LPA discussed the safe sleep regulations with Licensee, Norma Ruiz and Co-Licensee, Jose Luis Ruiz and discussed the Child Care Licensing Safe Sleep webpage at: https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

Report Continued On LIC809-C

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC809 (FAS) - (06/04)
Page: 8 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: RUIZ FAMILY CHILD CARE
FACILITY NUMBER: 364813844
VISIT DATE: 05/02/2024
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
26
27
28
29
30
31
32
- LPA also informed Licensee, Norma Ruiz and Co-Licensee, Jose Luis Ruiz of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at: https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

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: http://www.ada.gov/childqanda.htm

- Licensee, Norma Ruiz and Co-Licensee, Jose Luis Ruiz was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

- Community Care Licensing Division (CCLD) regularly sends information to licensed facilities, providers, and stakeholders by way of Provider Information Notices (PIN), Program Quarterly Update Newsletters and other important information communication platform. To receive important licensed-related information to licensed facilities, visit the CCLD Important Information website at:


https://www.cdss.ca.gov/inforesources/community-care-licensing/subscribe and select the Child Care option to receive email communication.

- The Duty Officer is available to answer questions Monday – Friday; 8:00am to 5:00pm at:951-782-4200

See LIC809-D for cited deficiencies.

Report Continued On LIC809-C

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC809 (FAS) - (06/04)
Page: 9 of 10
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: RUIZ FAMILY CHILD CARE
FACILITY NUMBER: 364813844
VISIT DATE: 05/02/2024
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
26
27
28
29
30
31
32
LPA Taityana Benson informed Licensee, Norma Ruiz and Co-Licensee, Jose Luis Ruiz that this report dated 05/02/2024 document(s) 03 Type A citation(s) which shall be posted for 30 consecutive days as there is/are immediate risk(s) to the health, safety, or personal rights of children in care.

A notice of site visit was given 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.



Also, LPA Taityana Benson informed the Licensee, Norma Ruiz and Co-Licensee, Jose Luis Ruiz to provide a copy of this licensing report dated 05/02/2024 that documents any Type A citation(s) to parents/guardians of all children currently enrolled by the next business day or the next day the children are in care, and to any newly enrolled parents/guardians for 12 months from the date of this report. A signed Acknowledgement of Receipt of Licensing Report (LIC 9224), or other written statement, must be placed in the child's file for verification.

The Licensee, Norma Ruiz and Co-Licensee, Jose Luis Ruiz, confirmed that there are no Registered Sex Offenders living in the facility and/or using the facility address for their mailing address.

Exit interview conducted and report was reviewed with the Licensee, Norma Ruiz and Co-Licensee, Jose Luis Ruiz

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Taityana Benson
LICENSING EVALUATOR SIGNATURE:

DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024
LIC809 (FAS) - (06/04)
Page: 10 of 10