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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 330927937
Report Date: 11/29/2022
Date Signed: 11/29/2022 02:15:45 PM

Document Has Been Signed on 11/29/2022 02:15 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
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:ALLEN FAMILY DAY CAREFACILITY NUMBER:
330927937
ADMINISTRATOR:ALLEN, SYLVIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 236-0738
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:23 PM
MET WITH:Sylvia Allen, LicenseeTIME COMPLETED:
02:25 PM
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On 11/29/2022 at 1:23 PM, Licensing Program Analyst (LPA) Susan Brewer, arrived at the facility for the purpose of conducting a Case Management inspection. LPA was greeted by the licensee Sylvia Allen and granted entry into the facility. LPA took a census and present was the licensee, the licensee's spouse and no children were in care. The licensee Sylvia Allen, has requested to remain on Inactive Status and completed a new LIC9211 Request for Inactive Status form for dates beginning 11/29/2022 through 01/10/2024, at which time the licensee will determine if they can operate.

The licensee understands that they will not provide child care for which a license is required until the license is reactivated. The licensee agrees to continue to pay for annual licensing fees and will be in compliance with all licensing laws and regulations upon re-opening the facility and will inform the office of any changes.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, 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 up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

No citations issued.

No civil penalties issued.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the licensee Sylvia Allen, and a copy of this report was provided.
SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2022
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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