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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818501
Report Date: 06/07/2023
Date Signed: 06/07/2023 09:53:37 AM

Document Has Been Signed on 06/07/2023 09:53 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
364818501
ADMINISTRATOR:PEREZ, DOLORESFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 628-9819
CITY:CHINOSTATE: CAZIP CODE:
91710
CAPACITY: 14TOTAL ENROLLED CHILDREN: 6CENSUS: 4DATE:
06/07/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Dolores PerezTIME COMPLETED:
09:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Rachel Zeron made an unannounced case management visit to conduct a Heath & Safety check. LPA Zeron met with Licensee, Dolores Perez and explained the reason for the visit. LPA conducted a walk though of the home, took census and made observations. LPA observed four children in care. The children were observed to be safe and engaged in regular actives.

LPA did not observe any deficiencies at this time.

LPA Zeron conducted an exit interview and explained to the Licensee, Dolores Perez, that the Department would be making increased visits to ensure the health and safety of the children in care.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
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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