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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493006320
Report Date: 08/20/2019
Date Signed: 08/21/2019 04:06:08 PM

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:CARRILLO, ANGELICA FAMILY CHILD CARE HOMEFACILITY NUMBER:
493006320
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
08/20/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:14 AM
MET WITH:Angelica CarilloTIME COMPLETED:
11:05 AM
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A case management inspection was made to the facility by Licensing Program Analyst (LPA) Y. Yang due to overdue annual fees owed by the facility. LPA attempted to contact the licensee by telephone on 08/19/19. LPA reminded licensee that annual fees are payable by check or money order or online through the Department’s website. LPA provided the licensee with the PIN number for use when paying online. During today's inspection, the licensee paid her annual fees online.

During today’s case management inspection, there were six children in the licensee’s care. LPA provided the licensee consultation with Title 22 regulations. In addition, LPA provided the licensee with information pertaining to the FCCH increase of capacity process. The licensee stated that she was considering applying for a large FCCH. This report, as well as the AAP Guide to Safe Sleep Practices and The Effects of Lead Exposure brochures, were 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.

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: 08/20/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2019
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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