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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334818751
Report Date: 10/12/2023
Date Signed: 10/12/2023 02:08:53 PM

Document Has Been Signed on 10/12/2023 02:08 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: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: 14CENSUS: DATE:
10/12/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Norma PerezTIME COMPLETED:
12:51 PM
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On date and time listed, Licensing Program Analyst (LPA) Sumayya Habeebulla and Licensing Program Manager (LPM) Carlos Martinez arrived at the facility to conduct a Case Management visit to ensure the daycare was in compliance in accordance to informal office conference conducted on 05/04/23. .

During this visit, LPA Habeebulla and LPM Martinez conducted an tour of the facility, both inside and out, took census and confirmed that the facility was in compliance as required.

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

A copy of this report must be made available to the public, at the facility, for 3 years.
SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Sumayya Habeebulla
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2023
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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