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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818501
Report Date: 07/20/2023
Date Signed: 07/20/2023 02:15:55 PM

Document Has Been Signed on 07/20/2023 02:15 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 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: 14CENSUS: 6DATE:
07/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Dolores Perez, LicenseeTIME COMPLETED:
02:30 PM
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On 07/20/23 at 12:30 p.m. an unannounced case management inspection was conducted by License Program Analysts (LPAs) Blanca Ruiz and Elyse Jones. LPA met with licensee, Dolores Perez. Upon arrival to the facility LPAs observe six children having lunch. This inspection was conducted in Spanish per Licensee’s request.

During this inspection no other individuals were present. LPAs toured the facility inside and out, and a census were taken. The purpose of the inspection is to follow up on a Health and Safety check of daycare children at the facility. Documents were collected during this visit.

No deficiencies were cited during inspection.

An exit interview was conducted with Licensee, Ms. Dolores Perez. A copy of this report was provided to the licensee on this date and must be made available to the public upon request for the next 3 years.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Blanca Ruiz-Silva
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2023
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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