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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334830066
Report Date: 06/28/2022
Date Signed: 06/28/2022 12:32:20 PM

Document Has Been Signed on 06/28/2022 12:32 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 STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
334830066
ADMINISTRATOR:JIMENEZ, ALICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 238-1751
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
06/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Alicia JimenezTIME COMPLETED:
12:45 PM
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On June 28,. 2022 at 12:03 PM, Licensing Program Analyst's (LPA's) Anastasia Flores and Lorena Valenzuela arrived, to conduct an unannounced compliance inspection. At 12:05 PM, LPA's were greeted and granted access into the home. Licensee Alicia Jimenez stated the facility is closed and has been closed since Covid begin in 2020. LPA's informed Licensee she has the option to remain inactive or to close her facility for good. Licensee stated she would like to remain inactive. LPA's observed there to be no children from day care present at the time of inspection. Licensee completed the inactive form, understands that she will need to have licensee annual fees current,and stay in compliance with all other licensing regulations. Licensee was asked to complete a new LIC279B and email to LPA Flores by 06/30/22.

Exit interview was conducted, report reviewed with licensee and appeal rights handed to Alicia Jimenez on June 28, 2022.
SUPERVISORS NAME: Stephanie Hudak
LICENSING EVALUATOR NAME: Lorena Valenzuela
LICENSING EVALUATOR SIGNATURE: DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/28/2022
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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