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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364817195
Report Date: 02/18/2021
Date Signed: 02/18/2021 04:26:05 PM

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:VERASTEGUI FAMILY CHILD CAREFACILITY NUMBER:
364817195
ADMINISTRATOR:VERASTEGUI, JESSICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 908-3326
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:14CENSUS: 0DATE:
02/18/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Jessica Verastegui/LicenseeTIME COMPLETED:
04:01 PM
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On 2/18/2021 at 3:00 PM, Licensing Program Analyst (LPA) Patricia Berry conducted a tele-inspection visit, via Face Time, due to COVID-19 and DPH guidelines of social distancing. The purpose of the tele-inspection visit is to conducted a case management- other inspection to review RAST assessment prior to licensee reopening her facility on 2/22. LPA made contact with the licensee, took a census and reviewed the RAST material with licensee. Licensee stated she understands the material presented to her today and will apply all RAST information to her facility upon reopening.

This report will be sent via email to the provided email address with an attached read receipt. A copy of LIC 9213- Notice of Site Visit will be sent via email along with the report. The read receipt will be used in lieu of the signature on the report.

All reports shall be maintained for three years.
SUPERVISOR'S NAME: Gilbert SenaTELEPHONE: (951) 782-4844
LICENSING EVALUATOR NAME: Patricia BerryTELEPHONE: (951) 782-4952
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2021
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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