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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 065406112
Report Date: 08/16/2022
Date Signed: 08/16/2022 04:02:43 PM


Document Has Been Signed on 08/16/2022 04:02 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926



FACILITY NAME:CERVANTES, PATRICIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
065406112
ADMINISTRATOR:CERVANTES, PATRICIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 908-2043
CITY:WILLIAMSSTATE: CAZIP CODE:
95987
CAPACITY:14CENSUS: 9DATE:
08/16/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Patricia CervantesTIME COMPLETED:
03:25 PM
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On 8/16/2022 at 2:55pm a case management inspection was made to the facility by Licensing Program Analyst (LPA), Laura Chavez and met with licensee Patricia Cervantes. The inspection was made in response to the licensee reporting that she removed the pool cover and has now made the pool inaccessible by surrounding the above ground pool with a fence. The fence is a 6 foot mesh fence which does not obscure the pool from view. The gate swings away from the pool and self-closes as required. The licensee agrees to maintain the fence in good repair as well as removing the ladder when the pool is not in use.

No deficiencies were cited during today's visit.

All licensing reports are public information and must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2022
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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