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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842800
Report Date: 01/29/2024
Date Signed: 01/29/2024 03:14:41 PM

Document Has Been Signed on 01/29/2024 03:14 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
INLAND EMPIRE CHILD, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:GUIRGUIS FAMILY CHILD CAREFACILITY NUMBER:
334842800
ADMINISTRATOR:GUIRGUIS,INASFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 797-6888
CITY:CORONASTATE: CAZIP CODE:
92883
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
01/29/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Inas Guirguis, LIcenseeTIME COMPLETED:
03:30 PM
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On 1/29/2024 at 2:00 PM, Licensing Program Analyst, Claudia Caywood, arrived at the facility to conduct a Case Management-POC inspection to follow up on Plan of Corrections (POCs) that were arranged at a prior inspection visit dated 12/27/2023.

During today's inspection a Fire & Earthquake drill POC was cleared. LPA advised the licensee they will need to submit children’s immunization's, LIC9224’s for all enrolled children, and a copy of all infant children’s sleep log. Licensee agreed to submit outstanding POC’s by 2/5/2024.

An exit interview was conducted with licensee, Inas Guirguis. A copy of this report and a Notice of Site Visit was provided to the licensee on 1/29/2024.

Notice of Site Visit was given and must be posted for 30 days.

A copy must be made available upon request, to the public, for 3 years.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Claudia Caywood
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2024
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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