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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376619581
Report Date: 02/03/2025
Date Signed: 02/03/2025 11:27:16 AM

Document Has Been Signed on 02/03/2025 11:27 AM - 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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MUNOZ, ROSIE FAMILY CHILD CAREFACILITY NUMBER:
376619581
ADMINISTRATOR/
DIRECTOR:		ROSIE MUNOZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 842-7035
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
02/03/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:10 PM
MET WITH:Licensee Rosie MunozTIME VISIT/
INSPECTION COMPLETED:
11:25 PM
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Licensing Program Analyst (LPA) Hayley McCarthy and Licensing Program Manager (LPM) Deborah Mullen conducted a case management visit to follow up on an Unusual Incident Report involving child #1 (C1). The incident involved C1 falling and sustained a cut under their chin while they were washing their hands. LPA Obtained clarifying information regarding the incident and reviewed C1's file. C1 has a medical condition which unexpectedly will cause C1's body to go limp which can result in a fall.

Nothing further is needed at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to the licensee.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Hayley McCarthy
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
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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