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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393613011
Report Date: 12/17/2020
Date Signed: 12/30/2020 03:31:51 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:CANTU, MARIAFACILITY NUMBER:
393613011
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
12/17/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maria CantuTIME COMPLETED:
10:30 AM
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At 9:00am Licensing Program Analyst(LPA) Aruna Sridharan facetimed with the licensee Maria Cantu for tele-inspection due to State Emergency Order for COVID-19. The tele-inspection is licensee initiated as licensee applied for a capacity increase from eight to 14 children LPA toured all areas of the home that are accessible to children, today’s census was 4 preschoolers and 1 infant. LPA confirmed that all adults residing in the home have been finger print cleared through Community Care Licensing.

Off-limit areas include: garage and entire upstairs. Licensee acknowledged that children may never enter these off-limit areas. LPAs observed a current roster of the enrolled children and fire drill log. The Fire Safety Inspection Clearance has been received from the Stockton Fire department and the home has been cleared for up to 14 children.

Effective today 12/17/2020. LPA is granting a large license to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Kindergarten or elementary school and 1 child at least age 6 with a maximum of 3 infants. Infants are children under the age of 2 years old. Licensee acknowledges that when there is no assistant present, facility will revert back to the small capacity. Licensee acknowledges that children residing in the home under the age of 10 years shall be included in capacity.
In the areas that were evaluated, no deficiencies were observed. Exit interview conducted and Notice of Site Visit posted.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2020
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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