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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334814522
Report Date: 10/03/2023
Date Signed: 10/03/2023 11:13:30 AM

Document Has Been Signed on 10/03/2023 11:13 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MOORE FAMILY CHILD CAREFACILITY NUMBER:
334814522
ADMINISTRATOR:MOORE, LAKEYCHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 488-1074
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
10/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Sarina MooreTIME COMPLETED:
11:20 AM
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Licensing Program Analysts (LPAs), Sumayya Habeebulla and Cindy Hamilton arrived at this facility to deliver an amended report for the deficiency cited on 06/29/23. Present during this visit was facility representative Ms. Serina Moore.

Facility Representative contacted Ms. Lakeycha Moore who stated the report can be signed by Ms. Serina Moore since Licensee was out for a run.

An exit interview was conducted, and this report was reviewed with facility representative Ms. Serina Moore. Appeal rights were discussed and provided during the exit interview. Notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2023
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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