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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844177
Report Date: 05/20/2022
Date Signed: 05/20/2022 04:00:40 PM

Document Has Been Signed on 05/20/2022 04:00 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:PINEDA FAMILY CHILD CAREFACILITY NUMBER:
334844177
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
05/20/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Licensee Eva Pineda.TIME COMPLETED:
04:05 PM
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On 05/20/2022 at 3:00 PM, Licensing Program Analyst Susan Brewer, arrived at the facility unannounced for the purpose of conducting a Case Management Inspection and verify a Plan of Correction for Licensee Eva Pineda. The LPA was greeted by the Licensee Eva Pineda and granted entry into the home to inspect Inside and out. LPA conducted a census of 6 children children present and in care at the facility, 2 infants under 24 months old and 4 toddlers ages 2-4 years old. LPA reviewed facility and children's records, gathered updated information for the facility to verify corrections for 3 Type A citations issued on 05/11/2022. The facility was found to be in compliance during the inspection and 3 Type A citations were cleared during todays inspection.

No citations issued.

No civil penalties issued.

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

Exit interview conducted and report was reviewed with the licensee Eva Pineda.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2022
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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