<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009999
Report Date: 10/07/2021
Date Signed: 10/07/2021 02:28:21 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: 8DATE:
10/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Diana CuevasTIME COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
A Case Management in-person inspection was made to the facility by Licensing Program Analyst (LPA), Leticia Rosales-Meza for the purpose to ensure the in-ground swimming pool fencing meets Title 22 Regulations. LPA observed that the pool's fencing is five feet tall and constructed of see-through DIY durable mesh material fencing that does not obstruct the view of the pool. The slats are 2.5 inches apart. LPA observed the wrought iron gate is self-latching, self-closing, and opens away from the pool. The gate latch is no more than six inches from the top of the gate. The pool fencing meets Title 22 regulation requirements. The backyard is on-limits to day care children and is fully fenced. Licensee understands that the Department has a zero tolerance policy against accessible bodies of water. Licensee understands that the pool fencing shall be in good repair at all times and must surround the pool. The Licensee has also installed alarms on the sliding doors in the family room and kitchen. The sliding door located in the family room is also latched and bolted on top of sliding door. This report was reviewed and discussed with the Licensee.

There were no deficiencies observed during today's visit.


Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5036
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1