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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009999
Report Date: 10/19/2020
Date Signed: 08/11/2021 01:32:15 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:CUEVAS, DIANA FCCHFACILITY NUMBER:
493009999
ADMINISTRATOR:CUEVAS, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 774-2318
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY:14CENSUS: 0DATE:
10/19/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Diana CuevasTIME COMPLETED:
11:30 AM
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A second Pre-licensing Zoom video conference inspection was conducted today by Licensing Program Analyst (LPA), Leticia Rosales-Meza. The applicant is Spanish Speaking. Due to the COVID-19, the Department has suspended all field operations, and the applicant agreed to attend the Tele-Inspection conference with LPA. The purpose for the video inspection was to inspect items identified during the video inspection on 10/16/20 needing to be corrected.

Licensee has installed a fence around the in-ground swimming pool. During today's video inspection LPA observed the in-ground swimming pool located in the backyard surrounded by a five foot fence. The slats are 2.5 inches apart. The fence does not obscured the pool from view. There is a self closing and self latching gate that swings away from the pool. The gate will be key locked. The backyard is off-limits to the day care children.

SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020
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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