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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376300704
Report Date: 07/03/2024
Date Signed: 07/03/2024 03:15:41 PM

Document Has Been Signed on 07/03/2024 03:15 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
RIVERSIDE SE CC RO, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501
FACILITY NAME:RIVERA-CRUZ FAMILY CHILD CAREFACILITY NUMBER:
376300704
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 7CENSUS: 6DATE:
07/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Carla Rivera-CruzTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On July 3, 2024, Licensing Program Analyst (LPA) Keely Messerschmidt conducted a case management visit in response to the receipt of an unusual incident report (UIR) from the facility. The UIR was reported to Community Care Licensing (CCL) on 6/27/2024.  

During this visit LPA conducted interview with Licensee and reviewed facility records relating to incident that took place on June 26th, 2024 involving child #1 (C1).

No further information is needed at this time.

An exit interview was conducted and a copy of this report, appeal rights and notice of site visit was provided to Licensee.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Keely Messerschmidt
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2024
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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