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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 065407857
Report Date: 10/20/2021
Date Signed: 10/20/2021 11:53:44 AM

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, DIANA FAMILY CHILD CARE HOMEFACILITY NUMBER:
065407857
ADMINISTRATOR:CERVANTES, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 870-7719
CITY:WILLIAMSSTATE: CAZIP CODE:
95987
CAPACITY:14CENSUS: 5DATE:
10/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Diana CervantesTIME COMPLETED:
11:55 AM
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On 10/20/2021 at 11:40am, Licensing Program Analyst (LPA) Laura Chavez conducted an Annual Random inspection. The facility file was reviewed prior to this visit. A review of the Facility Personnel Report Summary dated 10/19/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances. Currently two adults and two minors reside in the home. The home and grounds were toured, and the licensee and her assistant were operating within the licensed capacity. No children were observed in parked cars. The licensee's days and hours of operation are Monday-Friday, 7am-5pm. There is a working telephone in the home. The floor & yard plan were verified. The home is clean and orderly, with ventilation for safety and comfort. LPA observed toys, play equipment and materials available for children to be safe. The fire extinguisher, smoke detector and carbon monoxide detector in the home meet the standards required. Detergents, cleaning compounds, medications, and other items which could pose a danger to children are stored and inaccessible to children. Poisons are locked in the garage. The licensee stated there are no firearms and/or other dangerous weapons in the home, and none were observed during today's inspection. Eleven children’s records were reviewed at 11:30am, and contained emergency identification as required. The licensee understands that any child showing signs of illness shall be separated from other children. The licensee has completed the Mandated Reporter Training as required. The licensee's CPR and First Aid expire 11/11/2022. The licensee's immunization's are on file.

Report Continued: See LIC809-C
SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Laura ChavezTELEPHONE: (530) 895-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: CERVANTES, DIANA FAMILY CHILD CARE HOME
FACILITY NUMBER: 065407857
VISIT DATE: 10/20/2021
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The children use the fenced in back yard as their outdoor play area. The There were no pools or other bodies of water observed in or around the property. This report was reviewed and discussed with the Licensee. 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: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
LIC809 (FAS) - (06/04)
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