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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844177
Report Date: 07/18/2023
Date Signed: 07/18/2023 11:50:32 AM

Document Has Been Signed on 07/18/2023 11:50 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 SE CC RO, 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: 0DATE:
07/18/2023
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Eva Pineda TIME COMPLETED:
12:00 PM
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On 7/18/23, Eva Pineda came to the office for a non-compliance conference, present during the conference were Regional Manager, Stephanie Hudak, Licensing Program Manager Pauline Beschorner, Licensing Program Analyst William Chancellor and licensee Eva Pineda along with spouse Albert Pineda.

The following items were discussed:

Staffing Ratio and Capacity and Criminal record clearance.

Licensee has submitted an application requesting a capacity increase. The capacity increase will be granted once the fire equipment is installed and a fire clearance has been obtained. Licensee will remain in compliance of a small license until the capacity increase for a large has been approved.

Licensee understands that she will be placed in a compliance plan for a period of one year, which includes unannounced required visits by the department. If the department determines that the licensee has violated the law or regulations it may refer the facility for revocation or other appropriate administrative action.

This report was reviewed and give to the licensee Eva Pineda.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: William M Chancellor Jr.
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2023
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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