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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530267
Report Date: 01/03/2025
Date Signed: 01/03/2025 11:09:40 AM

Document Has Been Signed on 01/03/2025 11:09 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:SUMMER BREEZE CARE HOMEFACILITY NUMBER:
365530267
ADMINISTRATOR/
DIRECTOR:		DELFIN, RAINIERFACILITY TYPE:
740
ADDRESS:7461 HELLMAN AVETELEPHONE:
(909) 294-5291
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY: 6CENSUS: 5DATE:
01/03/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Rainier Delfin, AdministratorTIME VISIT/
INSPECTION COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Javier Prieto conducted an announced follow up Prelicensing visit 10/26/2023. This is an announced second Pre-Licensing visit conducted with Licensee, Rainer Delfin who assisted in the tour of inside and outside of facility and the evaluation. The follow up visit was made to confirm that the correction has been made.

An active land line and working telephone has been corrected. Facility working telephone number is (909) 294-5291.

The facility was evaluated in accordance with the California Code of Regulations (CCR), Title 22. Based on the observations and evaluation of the facility this date, the facility is ready for licensure. LPA completed COMP III with the Licensee at the conclusion of the inspection.


Licensee will be notified once facility is licensed.

An exit interview was conducted, and a copy of this report (LIC809) was discussed and provided with Licensee, Rainier Delfin.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2025
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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