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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334846152
Report Date: 08/22/2024
Date Signed: 08/22/2024 12:28:24 PM

Document Has Been Signed on 08/22/2024 12:28 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
RIVERSIDE CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:DIAZ FAMILY CHILD CAREFACILITY NUMBER:
334846152
ADMINISTRATOR/
DIRECTOR:		DIAZ, JEANETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 706-9225
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
91752
CAPACITY: 14TOTAL ENROLLED CHILDREN: 4CENSUS: 2DATE:
08/22/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Licensee Jeanette DiazTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
NARRATIVE
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On the above date at 9:15 AM Licensing Program Analyst (LPA) Susan Brewer, arrived at the facility for the purpose of conducting an inspection on a separate matter. The LPA was greeted by the Licensee Jeanette Diaz and granted entry to tour the facility inside and out. LPA conducted a census of 2 children in care. Present were the Licensee and 1 other adult resident.

During the course of the inspection regarding a separate matter, it was determined that on 05/10/2024 an incident occurred during daycare operation hours and the licensee Jeanette Diaz, did not notify the Community Care Licensing Child Care Department of the incident. It was reported to the department that on the morning of 05/10/2024, 2 law enforcement officers came to the facility during daycare hours of operation and in the presence of daycare children and other non-resident adults. By the licensee Jeanette Diaz's own admission, the 2 officers were dispatched to the facility for a well-ness check and met with the Licensee and another adult resident, then left after approximately 10 minutes. The licensee admitted to not reporting the incident to the department. Therefore, it was determined that the licensee Jeanette Diaz is in violation of reporting requirements under Title 22 regulations.

A Type B violation was cited on today's date.

No civil penalties were issued.

An exit interview was conducted and a copy of this report was provided to the Licensee Jeanette Diaz, on this date.

A Notice of Site Visit was issued and must remain posted for 30 days. The LPA observed the licensee post the Notice of Site Visit prior to exiting the facility.
SUPERVISORS NAME: Ana Noble
LICENSING EVALUATOR NAME: Susan Brewer
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2024
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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Document Has Been Signed on 08/22/2024 12:28 PM - It Cannot Be Edited


Created By: Susan Brewer On 08/22/2024 at 11:43 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: DIAZ FAMILY CHILD CARE
FACILITY NUMBER: 334846152

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/30/2024
Section Cited
CCR
102416.2(b)

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102416.2 Reporting Requirements (b) The licensee shall report to the Dept. any of the events as specified in Health & Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home.
This regulation was not met as evidenced by:
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The licensee Jeanette Diaz, agrees to ensure they report to the Dept. any of the events as specified in Health & Safety Code Sections 1597.467(b)(1)(A) through (b)(1)(C) that occur during the operation of the family child care home as required.
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Based on LPA record review and interviews conducted and by the licensee's own admission, the licensee did not report an incident of law enforcement contact and presence at the facility on 05/10/2024, during daycare hours, which is a potential risk to the health & safety of children in care.
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In addition, the licensee agrees to submit the LIC624 Unusual Incident Report form, describing the unusual events that took place on 05/10/2024 and submit the report to the department by fax, mail or e-mail on or before 08/30/2024.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Ana Noble
LICENSING EVALUATOR NAME:Susan Brewer
LICENSING EVALUATOR SIGNATURE:
DATE: 08/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/22/2024


LIC809 (FAS) - (06/04)
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