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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334820537
Report Date: 10/12/2022
Date Signed: 10/12/2022 10:38:24 AM

Document Has Been Signed on 10/12/2022 10:38 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:LUCAS FAMILY CHILD CAREFACILITY NUMBER:
334820537
ADMINISTRATOR:KIZZY LUCASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 742-7986
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/12/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kizzy LucasTIME COMPLETED:
10:45 AM
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On 10/12/2022 at 10AM Licensing Program Analyst (LPA) Giselle Carbullido arrived at the facility to conduct an annual inspection. LPA was granted entry by Licensee, Kizzy Lucas. Licensee opted to go inactive due to not having any children in care for 2 years. LPA observed and/or discussed the following : Normal days and hours of operation are Monday- Friday, 23 hours OFF-LIMIT AREAS INCLUDE: The master bedroom and master bathroom, the second bedroom and the garage.

Licensee informed LPA that she is not currently operating the day-care. LPA informed Licensee of her options to close the license or continue license on inactive status. LPA Carbullido provided information regarding inactive status verses closing the facility. Ms. Lucas requested to go inactive effective today and submitted LIC9211.

LPA explained Inactive status and the Licensee agreed to the following: Licensee will not provide child care for which a license is required until my license is reactivated. Licensee will continue to pay the annual license fee by the annual date due. Licensee understands that failure to pay the annual license fees will result in the closure of the facility.

Licensee will inform the Licensing Office (RO) of any changes in the inactive dates by submitting a new LIC9211, before the expiration date. Licensee understands an inspection is necessary prior to re-opening the facility and will contact the assigned analyst prior to re-opening the facility to request an inspection.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2022
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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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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME: LUCAS FAMILY CHILD CARE
FACILITY NUMBER: 334820537
VISIT DATE: 10/12/2022
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Licensee will comply with all licensing laws and regulations upon re-opening the facility, including but not limited to: Ensuring all adult staff and residents, including children who turn 18 during the inactive period, have criminal record clearances.

Licensee will ensure compliance with all new legislation and/or regulations. Licensee will maintain current CPR, First Aid, and Mandated Reporter Certifications. Licensee will maintain a current fire extinguisher, carbon monoxide, and functioning smoke alarms and/or detectors.

Exit interview was conducted with Licensee, Ms. Lucas and a copy of this report was provided during this visit.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC809 (FAS) - (06/04)
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