<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334840756
Report Date: 03/21/2024
Date Signed: 03/21/2024 11:13:57 AM

Document Has Been Signed on 03/21/2024 11:13 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:ISLAS FAMILY CHILD CAREFACILITY NUMBER:
334840756
ADMINISTRATOR:ISLAS, SOCORROFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 329-2486
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY: 14TOTAL ENROLLED CHILDREN: 9CENSUS: 8DATE:
03/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Socorro Islas, LicenseeTIME COMPLETED:
11:20 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/21/2024 at 10:25 AM Licensing Program Analysts (LPA) Susan Brewer conducted an unannounced case management visit to follow up on a Confirmation of Removal for David H. Islas, which was issued on 02/29/2024. LPA was greeted by Licensee Socorro Islas and granted entry into the facility. Present were the licensee, the licensee’s spouse and 1 other adult. LPA S. Brewer toured facility and a census was taken of 8 children in care and the following was discussed:

LPA S. Brewer explained the written Confirmation of Removal for David H. Islas. The licensee Socorro Islas stated that Mr. David H. Islas is their son and no longer resides in the home as of 03/09/2024. The licensee Socorro Islas signed the Confirmation of Removal on 03/09/2024, following receipt of the notification. LPA verified the signed LIC 995B Addendum to Notification of Parents' Rights forms, located in the children’s files. During the inspection the licensee Socorro Islas completed the LIC279A Application form and the LIC279B to confirm current adults and children residing in the home.

Based on evidence obtained during today's visit, the LPA has verified the individual David H. Islas is not present, employed or residing in the facility.

An exit interview was conducted, and a copy of this report was left with Licensee Socorro Islas.

A Notice of Site visit was issued and must remain posted for up to 30 days. LPA verified posting prior to exiting the facility.

Verification of removal is complete.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1