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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845737
Report Date: 10/03/2024
Date Signed: 10/03/2024 09:49:20 AM

Document Has Been Signed on 10/03/2024 09:49 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:MEDINA FAMILY CHILD CAREFACILITY NUMBER:
334845737
ADMINISTRATOR/
DIRECTOR:		MEDINA,YARAVIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(760) 910-0142
CITY:COACHELLASTATE: CAZIP CODE:
92236
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/03/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:25 AM
MET WITH:Yaravi MedinaTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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On 10/03/2024 at 8:25am, Licensing Program Analyst (LPA) Gabriela Hernandez arrived at the facility to conduct a Case Management visit to ensure the daycare was in compliance in accordance with the non-compliance conference conducted on 06/25/2024.

During this visit, LPA conducted a tour of the facility, both inside and outside. Licensee has 6 children enrolled, however at the time of the visit, there were no children present.

LPA reviewed the following records:

· Licensee's Mandated Reporter Training expires 10/18/2024

· Licensee's Pediatric CPR and First Aid Card expires 09/2026.

· Health & Safety Certificate - completed on 08/26/2017.



· Facility Sketch, Emergency Disaster Plan and Notification of Parent’s Rights poster are posted.

· Documentation of fire and disaster drills are on file – Last drill was conducted on 08/11/2024.

No deficiencies were cited during this visit; technical violations were issued.



An exit interview was conducted, and this report and appeal rights were reviewed with licensee Yaravi Medina.

A notice of site visit was given and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Pauline Beschorner
LICENSING EVALUATOR NAME: Gabriela Hernandez
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2024
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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