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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173009884
Report Date: 05/06/2021
Date Signed: 05/06/2021 09:42:34 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:RIVERA, ELIZABETH FCCHFACILITY NUMBER:
173009884
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 7DATE:
05/06/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Elizabeth RiveraTIME COMPLETED:
08:30 AM
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The facility inspection was conducted via tele-inspection due to the Covid-19 state of emergency pandemic. The department has suspended all field operations and the applicant has agreed to conduct the video conference with LPA, (Licensing Program Analyst) Glenn Ouye.

LPA Ouye met with Elizabeth Rivera via televisit to conduct a capacity increase case management inspection. The licensee has toured LPA through the day care on-limits area. The licensee activated the carbon monoxide and smoke detectors for LPA. LPA viewed the fire extinguisher rated at 2A10BC. The fire inspection was conducted by Fire Inspector Smith of the Lake County Fire Protection District. LPA spoke with the inspector on 4/20/2021 and he indicated that he approved the home including the finished garage for child care use. The licensee stated that she does emergency disaster drills monthly and will log the drills. LPA will send a copy of the child and staff ratio guide to the licensee.

The licensee is approved as a large Family Child Care Home effective 5/6/2021.
A new updated license will be sent to the licensee along with this report and the child/staff ratio.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021
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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