<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233010040
Report Date: 06/10/2022
Date Signed: 06/10/2022 10:01:35 AM


Document Has Been Signed on 06/10/2022 10:01 AM - 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:JACINTO, JUAN CARLOS FCCHFACILITY NUMBER:
233010040
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
06/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Juan JacintoTIME COMPLETED:
10:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Glenn Ouye met with licensee Juan Jacinto to conduct a capacity increase. The licensee submitted the capacity increased application on April 12, 2022. The approved fire clearance was received by the department on June 6, 2022. A copy of the fire clearance was given to the the licensee.

LPA Ouye verified functioning smoke detector and carbon monoxide detectors. The fire extinguisher rated at 2A10BC is located in the kitchen/dining room and the pull station fire alarm is mounted on the wall next to the fire extinguisher.

The facility is now approved for a capacity increase from a small family child care home to a large family child care home effective June 10, 2022.

A new license with a capacity limit of 14 will be sent to the licensee.

No deficiencies cited during the inspection.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1