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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334816040
Report Date: 05/18/2022
Date Signed: 05/18/2022 12:35:36 PM

Document Has Been Signed on 05/18/2022 12:35 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MONTEZ FAMILY CHILD CAREFACILITY NUMBER:
334816040
ADMINISTRATOR:MONTEZ, CASSANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 634-5994
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY: 12TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Cassandra MontezTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Alaina Wilburn arrived at the facility to conduct a case management visit. LPA met with Licensee Cassandra Montez. Licensee stated that she wishes to be placed on inactive status. Licensee was provided with Request for Inactive Status Form, LIC9211. Licensee completed LIC9211 and requested inactive status from 05/18/2022 through 07/11/2022.

LPA reminded Licensee that annual license fees must be paid promptly and before reopening the day-care, Mrs. Montez will contact the Department, if she wishes to end Inactive status early, or to extend Inactive Status once it expires. .

A NOTICE OF SITE VISIT WAS ISSUED AND LPA VERIFIED THAT IT WAS POSTED IN A PROMINENT LOCATION AT THE FACILITY BEFORE LEAVING. THE LICENSEE UNDERSTANDS THAT IT MUST REMAIN POSTED FOR THE NEXT 30 DAYS.

Exit interview was conducted with Cassandra Montez and a copy of this report was provided during visit. Copy of report must be maintained for 3 years and available to the public upon request.
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Alaina Wilburn
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2022
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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