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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336300586
Report Date: 10/17/2023
Date Signed: 10/17/2023 03:38:10 PM

Document Has Been Signed on 10/17/2023 03:38 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 SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:MCKENZIE FAMILY CHILD CAREFACILITY NUMBER:
336300586
ADMINISTRATOR:MCKENZIE, KIMBERLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 323-7121
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
10/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Kimberly MckenzieTIME COMPLETED:
03:45 PM
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Licensing Program Analysts (LPAs) Amber Shaw and Sumayya Habeebulla arrived at the facility to conduct a subsequent Case Management on this date and met with Kimberly Mckenzie, Licensee.


LPAs informed Kimberly Mckenzie that additional information was required for the adults living in the home as well as the children in care.


An exit interview was conducted, and a copy was provided this date.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Amber Shaw
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
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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