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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300353
Report Date: 03/21/2024
Date Signed: 03/21/2024 01:47:59 PM

Document Has Been Signed on 03/21/2024 01:47 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
RIVERSIDE SOUTH EAST, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MILLAR FAMILY CHILD CAREFACILITY NUMBER:
336300353
ADMINISTRATOR:MILLAR,AUDREYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 719-5523
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
03/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Audrey MillarTIME COMPLETED:
02:05 PM
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On March 21 2024, at 1:00 PM Licensing Program Analyst(LPA) Courtnee Peebles arrived at the facility to conduct a case management visit. LPA toured the facility inside and out and took a census. LPA arrived at the facility to deliver an amended 9099 and 9099D for a complaint visit conducted on 03/14/2024. LPA explained to the licensee and incorrect regulation was placed on the deficiency page 9099D. A corrected form and report was given today.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Courtnee Peebles
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024
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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