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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364807483
Report Date: 07/26/2024
Date Signed: 07/26/2024 12:42:59 PM

Document Has Been Signed on 07/26/2024 12:42 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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:EVANS FAMILY CHILD CAREFACILITY NUMBER:
364807483
ADMINISTRATOR/
DIRECTOR:		DEBRA EVANSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 347-4757
CITY:RIALTOSTATE: CAZIP CODE:
92377
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
07/26/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Debra EvansTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 07/26/2024 at 11:15 AM, Licensing Program Analyst (LPA) Tiffanie Diep met with Licensee Debra Evans for the purpose of an unannounced Plan of Correction (POC) inspection. LPA observed seven children present in the home with Licensee and their adult grandchildren (S1 and S2).

All individuals subject to a criminal record review have obtained a criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of five days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

During an annual inspection conducted on 06/25/2024, Licensee was issued two Type B citations as Licensee’s pediatric CPR and first aid certification expired and personnel records were not maintained for one staff (S2) present. During today’s visit, LPA verified Licensee’s pediatric CPR and first aid certification expires on 07/22/2026. LPA also verified the required personnel documents for S2. The deficiencies are cleared effective today, July 26, 2024. A POC letter was provided to Licensee.

An exit interview was conducted and report was reviewed with the licensee, Debra Evans. 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: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
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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