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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364818501
Report Date: 03/07/2024
Date Signed: 03/08/2024 12:07:27 PM

Document Has Been Signed on 03/08/2024 12:07 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: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: 5DATE:
03/07/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Dolores PerezTIME COMPLETED:
11:45 AM
NARRATIVE
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 Licensing Program Analysts (LPAs) Rachel Zeron and Blanca Ruiz arrived at the facility to conduct a Case Management-Legal/Non-Compliance inspection. This inspection is in agreement with, and as a result of a Non-Compliance Conference that took place on 12/05/2023, due to concerns associated with a recent complaint in regards to Personal Rights that was substantiated on 11/07/2023. This report was translated in Spanish at the Licensee's request by LPA Ruiz.

LPAs met with licensee Dolores Perez, toured the facility and conducted a census. Present in the home today were licensee and five children.

The following was observed and discussed:
  • Personal Rights: The facility was found to be in compliance at this time.
  • Supervision: The facility was found to be in compliance at this time.

No deficiencies were cited during today's inspection.

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. LPAs observed licensee post Notice of Site Visit prior to leaving the facility.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.


Exit interview conducted and report was reviewed with Licensee, Dolores Perez.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Rachel Zeron
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2024
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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