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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364805583
Report Date: 02/06/2025
Date Signed: 02/06/2025 09:45:04 AM

Document Has Been Signed on 02/06/2025 09:45 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: 8CENSUS: 7DATE:
02/06/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Katina CulpepperTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On 02/06/2025 at 9:15 AM, Licensing Program Analysts (LPAs) Tiffanie Diep and Chase Atherton met with Licensee Katina Culpepper for the purpose of an unannounced case management visit to deliver an amended report for a Plan of Correction (POC) inspection conducted on 12/09/2024. The civil penalties are being dismissed. LPAs observed seven children present in the home with Licensee. All individuals subject to a criminal record review have obtained a criminal record clearance.

There were no deficiencies cited at this time. An exit interview was conducted and report was reviewed with the licensee, Katina Culpepper. A notice of site visit was given 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: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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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