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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300465
Report Date: 07/26/2023
Date Signed: 07/26/2023 01:15:16 PM

Document Has Been Signed on 07/26/2023 01:15 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:GODINEZ-RAMOS FAMILY CHILD CAREFACILITY NUMBER:
336300465
ADMINISTRATOR:ALEJANDRA GODINEZ-RAMOSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 698-2924
CITY:COACHELLASTATE: CAZIP CODE:
92236
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
07/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Alejandra GodinezTIME COMPLETED:
01:25 PM
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On 07/26/2023, a case management visit is being conducted in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was received by the licensing agency on 06/14/2023. It indicates the Child 1 (C1) suffered and injury which resulted in treatment needed by a medical professional.

Facility records were reviewed, and licensee was interviewed. Based on information gathered, no immediate violations have been identified. However, LPA Lorena Valenzuela provided licensee with technical assistance regarding supervision and reporting requirements.

An exit interview was conducted and a copy of this report was provided to licensee, Alejandra Godinez.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2023
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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