<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364846537
Report Date: 06/25/2024
Date Signed: 06/25/2024 02:14:55 PM

Document Has Been Signed on 06/25/2024 02:14 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:CARRILLO FAMILY CHILD CAREFACILITY NUMBER:
364846537
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
06/25/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:22 PM
MET WITH:Licensee Julia CarrilloTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On the date and time listed, Licensing Program Analyst (LPA) Perla Ordones arrived at the facility in response to the receipt of an Unusual Incident Report (UIR) that was submitted by the facility. The UIR was received by the licensing agency on 06/17/2024. LPA was granted into the facility Licensee Julia Carrillo. LPA explained the purpose of the visit and conducted a facility tour to take census.

The UIR documents an incident pertaining to a day-care child who is no longer enrolled at the facility. LPA toured the entire home and LPA also obtained documentation relevant to the UIR. During the facility tour, LPA did not observe any hazards or other concerns inside or outside the home.

Based on the observations made and information gathered, there were no violations of Title 22 regulations identified at this time.

A notice of site visit was given and must remain posted for 30 days.

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

During the exit interview, the LICENSEE Julia Carrillo, confirmed that there are no Registered Sex Offenders living in the facility and LPA completed the RSO profile in FAS.

Exit interview conducted and report was reviewed with the licensee Julia Carrillo.
SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Perla Ordones
LICENSING EVALUATOR SIGNATURE: DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1