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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364841201
Report Date: 05/09/2024
Date Signed: 05/09/2024 02:11:38 PM

Document Has Been Signed on 05/09/2024 02:11 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:ORTIZ FAMILY CHILD CAREFACILITY NUMBER:
364841201
ADMINISTRATOR/
DIRECTOR:		ORTIZ, DONNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 781-9540
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
05/09/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:36 PM
MET WITH:Licensee Assistant Lisa MaslachTIME VISIT/
INSPECTION COMPLETED:
02:20 PM
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On 5-9-2024 and time listed above, Licensing Program Analyst (LPA) Steven Montoya arrived at the facility to conduct an Case Management Other to provided copy of the LIC 809 and LIC809D page during Annual inspection reports on 5-8-2024 (No report provided due to technical difficulty). LPA was granted entry by Licensee Assistant Lisa Maslach. LPA briefly toured the facility inside and out, took a ratio count of the children in care which meeting guidelines. LPA discussed and provided Assistant Licensee with title 22 regulation for ratio.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Steven Montoya
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2024
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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