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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364813437
Report Date: 07/11/2023
Date Signed: 07/11/2023 05:29:41 PM

Document Has Been Signed on 07/11/2023 05:29 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:ROCES-LOPEZ FAMILY CHILD CAREFACILITY NUMBER:
364813437
ADMINISTRATOR:ROCES-LOPEZ, JOCELYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 283-4195
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY: 14TOTAL ENROLLED CHILDREN: 20CENSUS: 15DATE:
07/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Licensee Jocelyn Roces-LopezTIME COMPLETED:
05:30 PM
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On the above date and time, Licensing Program Analysts (LPAs) Susan Brewer and Laura Mejorado, arrived at the facility for the purpose of Case Management visit and to deliver an amended report.

LPAs discussed and reviewed the LIC9099 amended report page with the Licensee Joceyln Roces - Lopez. During the visit LPAs Susan Brewer and Laura Mejoradto, conducted a census of 15 children.

An exit interview was conducted and a copy of this report was provided to licensee.

A notice of site visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
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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