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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845310
Report Date: 04/30/2024
Date Signed: 04/30/2024 04:35:50 PM

Document Has Been Signed on 04/30/2024 04:35 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
334845310
ADMINISTRATOR/
DIRECTOR:		JIMENEZ,PALMIRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 835-7815
CITY:BEAUMONTSTATE: CAZIP CODE:
92223
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
04/30/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:52 PM
MET WITH:Licensee Palmira JimenezTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
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On the date and time listed, Licensing Program Analysts (LPAs) Perla Ordones and Samuel Lopez arrived at the facility for the purposes of conducting an annual inspection and initiating a case management inspection in response to the receipt of an Unusual Incident Report (UIR) that was submitted by the facility on 04/18/2024. LPAs were granted entry into the home by the Licensee Palmira Jimenez. LPAs explained the purpose of today's inspection, completed a facility tour, and obtained a census.

LPAs made observations, reviewed pertinent documentation, and conducted interviews with pertinent parties related to the self reported incident. It was reported that on 04/12/2024, an authorized representative of a day-care child reported a potential mark on the child sometime after pick up. On or about 04/13/2024, the authorized representative reached out to the Licensee to inform them of the discrepancy. LPAs conducted interviews with pertinent parties. Licensee stated that they had not noticed any such mark and stated that authorized representatives are always informed of any possible injuries or other happenings at the day-care by the Licensee. The authorized representative disenrolled the child on 04/13/2024.

The department was unable to determine where the child sustained the mark therefore there was no citation issued at this time.

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

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Palmira Jimenez.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Perla Ordones
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2024
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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