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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009773
Report Date: 08/14/2020
Date Signed: 08/14/2020 11:04:36 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:PEREZ, EMILIO FCCHFACILITY NUMBER:
493009773
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
08/14/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Emilio PerezTIME COMPLETED:
07:45 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 licensee Emilio Perez to conduct a case management tele-visit for a capacity increase from a small FCCH to a large FCCH. The application for the capacity increase was received by the department on July 28, 2020.

The licensee toured LPA through the home to show a functioning combination smoke detector/carbon monoxide detector. The fire extinguisher rated at a minimum 2A10BC was wall mounted. The fire alarm pull station was also observed to be install. It was not tested by the LPA but the licensee said that the fire inspector tested the pull station. The licensee also explained the path of egress for the children in the event of an emergency evacuation.

The licensee has performed all of the physical plant requirements and is required to maintain regulations are it applies to large FCCH.

The capacity increase from a small FCCH to a large FCCH has been approved and is effective today on August 14, 2020.

A new license will be sent to the licensee.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2020
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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