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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 013423712
Report Date: 07/14/2023
Date Signed: 07/14/2023 01:17:00 PM

Document Has Been Signed on 07/14/2023 01:17 PM - 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:MOLINA, MITZYFACILITY NUMBER:
013423712
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
07/14/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Mitzy MolinaTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Cherie Acosta conducted an unannounced Case Management/Increase of Capacity inspection. Licensee has an approved fire clearance dated 5/15/23. Licensee has 3 years of experience as a licensed Family Child Care Home at a previous location. Present during today’s inspection was the licensee, 3 preschool aged children and 1 infant in care.

An inspection was previously completed on 5/31/23. During the inspection on 5/31/23 licensee was informed that the swing in the outdoor play area must be anchored to the ground. During today's inspection LPA observed the swing to be anchored to the ground for children's safety.

This increase in capacity to care for a maximum of 14 children is approved as of today, 7/14/23. LPA provided information and discussed ratios for a large family child care home.

Exit interview and report reviewed with Mitzi Molina.
Notice of Site Visit was provided and must be posted for 30 days.
SUPERVISORS NAME: Sherelle Johnson
LICENSING EVALUATOR NAME: Cherie Acosta
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2023
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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