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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300060
Report Date: 10/26/2022
Date Signed: 10/26/2022 12:16:23 PM

Document Has Been Signed on 10/26/2022 12:16 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:DEGUZMAN FAMILY CHILD CAREFACILITY NUMBER:
336300060
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:41 AM
MET WITH:Natasha Deguzman, LicenseeTIME COMPLETED:
12:25 PM
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On 10/26/2022 at 11:42 AM Licensing Program Analyst (LPA) LPA Susan Brewer, arrived at the facility for the purpose of conducting an Annual Inspection, which turned into a Case Management visit. LPA was greeted by the licensee Natasha DeGuzman at the facility. Present was the licensee and 1 resident minor. No children are enrolled at the facility and no inspection was conducted. The licensee Natasha DeGuzman, has requested to be on Inactive Status and completed the LIC9211 for dates beginning 09/06/2022 through 01/01/2023, at which time the licensee will determine if they can operate.

The licensee understands that they will not provide child care for which a license is required until the license is reactivated. The licensee agrees to continue to pay for annual licensee fees and will be in compliance with all licensing laws and regulations upon re-opening the facility and will inform the office of any changes.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

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 Natasha DeGuzman, and a copy was provided to the licensee on 10/26/2022.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2022
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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