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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844665
Report Date: 05/12/2023
Date Signed: 05/12/2023 10:14:22 AM

Document Has Been Signed on 05/12/2023 10:14 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:PLANOS FAMILY CHILD CAREFACILITY NUMBER:
334844665
ADMINISTRATOR:PLANOS, JEILYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 565-6492
CITY:PALM DESERTSTATE: CAZIP CODE:
92211
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
05/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Jeilyn PlanosTIME COMPLETED:
10:30 AM
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On 05/12/2023, Licensing Program Analyst (LPA) Lorena Valenzuela conducted an unannounced visit in response to the receipt of an unusual incident report (UIR) received from the facility on 05/04/2023. LPA met with licensee Jeilyn Planos.

The UIR states there was an incident on 05/02/2023, involving Child #1 (C1), incident which required medical care.

LPA interviewed licensee and observed nine children in care. Based on the information gathered the facility acted appropriately and no violations were identified. Per interview conducted, licensee was in communication with C1's parents, reported the incident timely to the Department and there were appropriate ratios and supervision.

An exit interview was conducted and a copy of this report was provided to licensee, Jeilyn Planos.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/12/2023
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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