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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334818751
Report Date: 05/04/2023
Date Signed: 05/04/2023 11:07:41 AM

Document Has Been Signed on 05/04/2023 11:07 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, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:PEREZ FAMILY CHILD CAREFACILITY NUMBER:
334818751
ADMINISTRATOR:NORMA PEREZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(626) 378-8372
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY: 14TOTAL ENROLLED CHILDREN: 19CENSUS: DATE:
05/04/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Norma PerezTIME COMPLETED:
11:20 AM
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Licensing Program Analyst (LPA) Sumayya Habeebulla, Licensing Program Manager (LPM) Carlos Martinez conducted an Informal Office Conference with Licensee, Norma Perez. The purpose of this meeting is to discuss recent concerns pertaining to Licensee’s child who is currently on probation and living with Licensee’s sister, Sylvia Perez until July 17, 2023.

This Informal Conference was called to discuss the following issues:

· LPM Martinez informed Licensee that if Licensee’s child returns to the facility where she is operating her childcare facility, the department will proceed with a Temporary Suspension Order (TSO) and will be required to seize operations immediately. The Licensee was also informed that CCL would take administrative action and pursue a revocation of the facility license.

· Licensee stated that her child will be relocating to the Licensee’s daughter’s house, and she will begin the process to obtain guardianship. The other option was to send her child with the Licensee’s nephew who lives in Mexico.

· Ms. Perez stated that if she can’t relocate her child, she will be contacting CCL and will close her facility.


See LIC 809C for continuation
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME: PEREZ FAMILY CHILD CARE
FACILITY NUMBER: 334818751
VISIT DATE: 05/04/2023
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· Deficiencies in record keeping such as updating Facility roster.

· Updating Children’s files with all the documents required upon enrollment.

· Updating Facility files for the Departmental Review during visits

· Updating staff /assistant files


LPM I Martinez reminded Ms. Perez of how important regulatory compliance is in licensed facilities to protect the Health and Safety of children in care. Ms. Perez has been informed the Licensing Agency takes these violations seriously, and how the violations can lead to the Department seeking legal action regarding the status of the license.

An exit interview was conducted. A copy of this report was reviewed with and provided to Licensee Norma Perez.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC809 (FAS) - (06/04)
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