<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364845095
Report Date: 10/02/2024
Date Signed: 10/02/2024 09:47:05 AM

Document Has Been Signed on 10/02/2024 09:47 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:GREEN FAMILY CHILD CAREFACILITY NUMBER:
364845095
ADMINISTRATOR/
DIRECTOR:		BRENDA GREENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 587-6270
CITY:ONTARIOSTATE: CAZIP CODE:
91764
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
10/02/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Brenda Green, licensee TIME VISIT/
INSPECTION COMPLETED:
10:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On the date and time listed above, Licensing Program Analysts (LPAs) Aman Lama and Justin Giese made an unannounced visit to the facility for the purpose of Proof of Corrections (POCs) from an unannounced inspection conducted on 05/31/2024. LPA's met with licensee, Brenda Green and discussed the purpose of the visit.

The following citation was cleared during todays visit:

1. HSC (Health and Safety Code): 1597.622(a)(1) Commencing September 1, 2016, a person shall not be employed or volunteer at a family day care home if he or she has not been immunized against influenza, pertussis, and measles. Each employee and volunteer shall receive an influenza vaccination between August 1 and December 1 of each year.

Assistant was able to show proof of immunizations (Tdap(pertussis), MMR(measles), Flu shot
Exit interview was conducted, and report was reviewed with licensee, Brenda Green.

LPA issued a Notice of Site Visit and verified it was posted in a prominent location at the facility. Licensees understands that the Notice of Site Visit must remain posted for the next 30 days.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Aman Lama
LICENSING EVALUATOR SIGNATURE: DATE: 10/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1