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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845434
Report Date: 05/19/2023
Date Signed: 05/19/2023 12:40:28 PM

Document Has Been Signed on 05/19/2023 12:40 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:TAYLOR FAMILY CHILD CAREFACILITY NUMBER:
364845434
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
05/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Tammy Loring, Facility Representative TIME COMPLETED:
12:55 PM
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On this date and time, Licensing Program Analyst (LPA) Laura Mejorado arrived at the facility on another matter. During today's inspection, LPA also conducted a Case Management inspection to discuss and provide the Licensee with regulatory information regarding Criminal Record Clearances and Criminal Record Exemptions. LPA met with facility representative Tammy Loring, toured the facility, and took census. Licensee was not present in the home but LPA was able to make contact with Licensee via phone and reviewed the report with Licensee over the phone. Licensee stated facility representative can sign the report.


LPA provided Licensee with a letter from Guardian Background Check System dated January 29, 2022, and another letter dated May 17, 2023, regarding a potential adult resident of the home. Licensee stated the adult resident does not reside in the home and agrees to provide a written declaration to LPA. Licensee understands prior to anyone residing, working or volunteering in the home, they must obtain a Criminal Record Clearance and/or a Criminal Record Exemption. Licensee acknowledges she understands the requirements. Licensee further agrees to abide by Title 22 Regulation section 102416.2(a)(2) entitled Reporting Requirements which indicates "... The licensee shall report the following information to the Department by telephone or fax within the Department's next business day and working hours (8am to 5pm)
: (2) Any change in household composition including adults moving in or out of the home and anyone living in the home who reaches his or her 18th birthday".

Exit interview was conducted with facility representative Tammy Loring. A copy of this report was provided to the facility.

This report must be made available at the facility for 3 years for public review upon request.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2023
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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