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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364804137
Report Date: 11/03/2022
Date Signed: 11/03/2022 10:24:01 AM

Document Has Been Signed on 11/03/2022 10:24 AM - 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:DAVIS FAMILY CHILD CAREFACILITY NUMBER:
364804137
ADMINISTRATOR:SANDRA DAVISFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 421-3617
CITY:BLOOMINGTONSTATE: CAZIP CODE:
92316
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
11/03/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sandra DavisTIME COMPLETED:
10:40 AM
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On 11/03/2022 at time listed above Licensing Program Analyst (LPA) Justin Giese made an unannounced visit to the facility for the purpose of proof of corrections for deficiencies cited on 10/25/2022 . LPA met with Licensee, Sandra Davis and was granted access to the facility. At time of visit no children were in care.

LPA made unannounced visit to the facility on 10/25/2022 to conduct a required 1 year inspection. Licensee was previously issued deficiencies on 10/25/2022 pertaining to staff immunization records, fire/disaster drill log and operation of a family chid care home, pertaining to the home being kept clean and orderly. LPA toured the home, reviewed records and discussed progress of corrections with Licensee. LPA observed on limits and common areas of the home to be free of clutter and an overall improvement in cleanliness of the home. LPA verified the stairs were properly barricaded and hazardous items remain inaccessible to children.

The following outstanding deficiencies have been cleared at time of this visit

1. Operation of a Family Child Care Home - The home shall be kept clean and orderly
2. Staff immunization's
3. Disaster drill log - Date of completion (10/28/2022)

Licensee will continue to make improvements to the home to maintain a safe and healthy environment for children in care. LPA will return at a later date to verify the improvements made during this visit are sustained.

Exit interview conducted and report was reviewed with Licensee, Sandra Davis.

A notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Justin Giese
LICENSING EVALUATOR SIGNATURE: DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/03/2022
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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