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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334818751
Report Date: 02/01/2024
Date Signed: 02/01/2024 09:59:26 AM

Document Has Been Signed on 02/01/2024 09:59 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 SE CC RO, 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: 2DATE:
02/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Norma PerezTIME COMPLETED:
10:10 AM
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Licensing Program Analyst (LPA) Amber Shaw arrived at the facility to conduct a Case Management Inspection for a pool. LPA Shaw met with Norma Perez (licensee), toured the facility and inspected the pool area.

During today’s inspection, LPA measured the pool fencing to ensure compliance with Title 22 Regulations. The fencing (mesh) was measured at least 5 feet in height and surrounded the entire pool with no obstruction. The gate is self-closing/latching and has a key lock. The gate swings away from the pool. LPA informed the licensee that the pool met Title 22 Regulations and was in compliance.

An exit interview was conducted, and a copy of this report was provided to the applicant on this date. A copy of must be made available to the public for 3 years.

SUPERVISORS NAME: Carlos Martinez
LICENSING EVALUATOR NAME: Amber Shaw
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
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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