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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845717
Report Date: 07/08/2022
Date Signed: 07/08/2022 12:39:39 PM

Document Has Been Signed on 07/08/2022 12:39 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 ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:JIMENEZ FAMILY CHILD CAREFACILITY NUMBER:
334845717
ADMINISTRATOR:TANYA JIMENEZFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(951) 413-9276
CITY:CABAZONSTATE: CAZIP CODE:
92230
CAPACITY: 12TOTAL ENROLLED CHILDREN: 12CENSUS: 0DATE:
07/08/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:23 AM
MET WITH:Tanya JimenezTIME COMPLETED:
12:50 PM
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On this date and time, Licensing Program Analysts (LPAs) Aman Sharma and Laura Mejorado arrived at the facility to clear a Plan of Correction (POC). Upon arrival, LPA's noticed a male exiting the home, getting into a car and driving off. Upon arrival, LPAs met with Licensee, Tanya Jimenez. Licensee told LPA's that her facility was closed for the day and no daycare children were present during the visit.

The POC was to submit proof of fingerprint clearance for A1 and A2. Licensee also provided a Declaration of her plan for A1 and A2 while their fingerprints are pending.

Licensee was spotted with A3 outside the home. Licensee informed LPA's of who A3 was and admitted to A3 visiting the home today. A3 is also mentioned on the Declaration of licensees plan.

An exit interview was conducted with Licensee Tanya Jimenez, a copy of this report was provided, and a Notice of Site visit was issued.
SUPERVISORS NAME: Kimberly Williams
LICENSING EVALUATOR NAME: Aman Sharma
LICENSING EVALUATOR SIGNATURE: DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/08/2022
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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