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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423691
Report Date: 12/14/2022
Date Signed: 12/14/2022 09:40:50 AM

Document Has Been Signed on 12/14/2022 09:40 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:ROJAS, ANGELINAFACILITY NUMBER:
013423691
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
12/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Angelina RojasTIME COMPLETED:
09:50 AM
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
LPA L. Dyer conducted an announced pre-licensing inspection. Present for the inspection is the applicant. This is the second inspection for this location. At the time of the first inspection, dated 11/09/22, it was requested that the applicant complete the following four (4) items to prepare the home to be licensed:

1. Cover sandbox area in backyard.
2. Place lock on hall door.
3. Insure that day care area is heated at a comfortable temperature for children in care.
4. Remove baby walker.

A review of the items listed above has been completed. The applicant has:

1. Removed the sandbox from the backyard, and covered the area with faux grass.
2. Placed a lock on hall door.
3. Heated the home to a comfortable temperature. (Although Family Child Care regulations do not list a home temperature, it was discussed with the applicant that she must keep her home at a comfortable temperature for children).
4. Removed the baby walker.

It is recommended that a license be issued to this Family Day Care Home pending receipt of all final clearances and the completion of all requirements. A license will be processed as soon as administratively possible.

Exit interview conducted. Appeal rights were discussed and given. This report must be available for public review for 3 years.
SUPERVISORS NAME: Loretta Dyson
LICENSING EVALUATOR NAME: Phyllis Dyer
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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