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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364813859
Report Date: 02/01/2024
Date Signed: 02/01/2024 09:46:07 AM

Document Has Been Signed on 02/01/2024 09:46 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
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:DOWNEY FAMILY CHILD CAREFACILITY NUMBER:
364813859
ADMINISTRATOR:DOWNEY, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(909) 463-5933
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91739
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
02/01/2024
TYPE OF VISIT:Required - 3 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Maria Downey/licensee
TIME COMPLETED:
10:15 AM
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On 2/1/24 at 8:20 am, Licensing Program Analyst (LPA) Patricia Berry arrived at the facility to conduct attempt an annual inspection as part of a compliance review. Licensee stated she would like to close her facility as of today. Licensee surrendered her license. LPA closed the facility today 2/1/24.

Exit interview conducted with licensee, report, appeal rights and notice of site visit issues.

SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Patricia Berry
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
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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