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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
336300726
Report Date:
10/04/2023
Date Signed:
10/26/2023 10:52:00 AM
Document Has Been Signed on
10/26/2023 10:52 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 SOUTH EAST
,
3737 MAIN STREET, STE 700
RIVERSIDE
,
CA
92501
FACILITY NAME:
CARPENTER FAMILY CHILD CARE
FACILITY NUMBER:
336300726
ADMINISTRATOR:
CARPENTER,ASHANTI
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(562) 235-3807
CITY:
MENIFEE
STATE:
CA
ZIP CODE:
92584
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
0
DATE:
10/04/2023
TYPE OF VISIT:
Collateral
UNANNOUNCED
TIME BEGAN:
09:25 AM
MET WITH:
Neighbor Interviews
TIME COMPLETED:
10:25 AM
NARRATIVE
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This report was created in error
SUPERVISORS NAME
:
Stephanie Hudak
LICENSING EVALUATOR NAME
:
Pauline Beschorner
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/04/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/04/2023
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
2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE SOUTH EAST
,
3737 MAIN STREET, STE 700
RIVERSIDE
,
CA
92501
FACILITY NAME:
CARPENTER FAMILY CHILD CARE
FACILITY NUMBER:
336300726
VISIT DATE:
10/04/2023
NARRATIVE
1
2
3
4
5
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This report was created in error
SUPERVISORS NAME
:
Stephanie Hudak
LICENSING EVALUATOR NAME
:
Pauline Beschorner
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/06/2023
LIC809
(FAS) - (06/04)
Page:
2
of
2