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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364805583
Report Date: 12/09/2024
Date Signed: 02/06/2025 09:44:14 AM

Document Has Been Signed on 02/06/2025 09:44 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:CULPEPPER FAMILY CHILD CAREFACILITY NUMBER:
364805583
ADMINISTRATOR/
DIRECTOR:		KATINA CULPEPPERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 218-0253
CITY:RIALTOSTATE: CAZIP CODE:
92376
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 7DATE:
12/09/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Katina CulpepperTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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This is an amended report

On 12/09/2024 at 9:15 AM, Licensing Program Analyst (LPA) Tiffanie Diep met with Licensee Katina Culpepper for the purpose of an unannounced Plan of Correction (POC) inspection. LPA observed seven children present in the home with Licensee.

During an annual inspection conducted on 10/28/2024, Licensee was issued two Type B citations as Licensee’s pediatric CPR and first aid certification expired on 08/27/2024 and required immunizations were not maintained for one staff (S2) present. During today’s visit, LPA verified Licensee’s proof of enrollment for training course scheduled for 12/14/2024. The deficiency for Licensee’s pediatric CPR and first aid is cleared effective today, December 9, 2024. A POC letter was provided to Licensee. Licensee had agreed to submit the required immunizations for S2. The POC due date was agreed upon for 11/28/2024; however, the POC for S2’s immunizations has not been received as of 12/09/2024.

An exit interview was conducted and report was reviewed with the licensee, Katina Culpepper. A notice of site visit was given to Licensee and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Tiffanie Diep
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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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