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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845123
Report Date: 11/13/2023
Date Signed: 11/13/2023 04:19:16 PM

Document Has Been Signed on 11/13/2023 04:19 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:BOROSKI FAMILY CHILD CAREFACILITY NUMBER:
334845123
ADMINISTRATOR:BOROSKI,MISHELLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 488-4255
CITY:CHERRY VALLEYSTATE: CAZIP CODE:
92223
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
11/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Licensee Mishell Boroski and Assistant Denise LopezTIME COMPLETED:
04:30 PM
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 this date and time, Licensing Program Analysts (LPAs) Laura Mejorado and Perla Ordones arrived at the facility to conduct a case management inspection, LPAs met with Licensee Mishell Boroski and Assistant Denise Lopez. Licensee advised LPAs she wishes to retire. During the visit, Licensee voluntarily surrendered her license to allow another adult resident to be licensed at the existing facility address. LPAs advised Licensee the day care license will need to be closed prior to licensing the pending Family Child Care application.

Licensee was advised if she wishes to operate a day care facility again in the future, she will have to reapply for a license. Licensee was advised there can only be one license per residential address. Providing child care without a license is illegal. However, a license is not needed in the following situations:

(1) The children being cared for are related by blood or marriage to you.

(2) The children being cared for are from one family in addition to your own children.

An exit interview was conducted, a notice of site was issued and a copy of this report was provided to Assistant Denise Lopez.

SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Laura Mejorado
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2023
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