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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844177
Report Date: 06/06/2023
Date Signed: 06/06/2023 11:02:06 AM

Document Has Been Signed on 06/06/2023 11:02 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 SOUTH EAST, 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: 8DATE:
06/06/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Eva PinedaTIME COMPLETED:
11:30 AM
NARRATIVE
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On June 6, 2023, Licensing Program Analyst (LPA) William Chancellor and Licensing Program Manager (LPM) Pauline Beschorner arrived at the family childcare home and met with licensee Eva Pineda. The purpose of the visit was to verify plans of corrections from a previous inspection. While conducting the visit, LPA conducted a census of eight children, three were infants under the age of 24 months and none of the children were school age.

Licensee showed proof of immunization's for C5 and C6 and the LIC 9227 for C6. The plans of corrections letters will be sent.

LPA informed licensee she was over capacity and not operating within the limits specified on her license. Licensee stated that she submitted an application for an increase, but LPA Chancellor clarified that it was returned to the office. LPM discussed developing and providing a letter for parents today to give a two-weeks’ notice to find alternative care and un enroll three children.

The facility is being cited for Title 22, Regulation Section 102416.5 (a) Staffing Ratio and Capacity. An exit interview was conducted a copy of this report was provided along with appeal rights which were discussed and provided to Licensee Eva Pineda. A Notice of Site Visit was also provided and must remain posted for 30 days and a copy of the LIC 9224 must be provided to all parents.

Deficiencies will be cited on 809-D and civil penalties will be assessed.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: William M Chancellor Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/06/2023
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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Document Has Been Signed on 06/06/2023 11:02 AM - It Cannot Be Edited


Created By: William M Chancellor Jr. On 06/06/2023 at 10:41 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501

FACILITY NAME: PINEDA FAMILY CHILD CARE
FACILITY NUMBER: 334844177

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/20/2023
Section Cited
CCR
102416.5(a)

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102416.5(a) The capacity specified on the license shall be the maximum number of children for whom care may be provided at
any one time.
This requirement was not met as evidenced by:
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Licensee agrees to email a copy of the letter provided to parents by COB 6/6/23 and to update the children’s roster and provide a copy to LPA by COB 6/20/23. All parents must sign LIC 9227.
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LPA observed there to be 3 infants, and 5 children under the age of 5 present.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Pauline Beschorner
LICENSING EVALUATOR NAME:William M Chancellor Jr.
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2023


LIC809 (FAS) - (06/04)
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