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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493003383
Report Date: 09/23/2019
Date Signed: 09/24/2019 09:07:26 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:MENDEZ, ALEJANDRA FAMILY CHILD CARE HOMEFACILITY NUMBER:
493003383
ADMINISTRATOR:MENDEZ, ALEJANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 838-9123
CITY:WINDSORSTATE: CAZIP CODE:
95492
CAPACITY:14CENSUS: 9DATE:
09/23/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Alejandra MendezTIME COMPLETED:
01:39 PM
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A case management visit was made to the facility by Licensing Program Analyst (LPA) Y. Yang at the request of the licensee to provide consultation and speak regarding infant safe sleep best practices and the proposed safe sleep regulations. In addition, LPA spoke to the licensee regarding the process for adding a co licensee to her license. During today's visit, there were nine children being supervised by three staff members.

Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's inspection.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Yang YangTELEPHONE: 707-588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2019
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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