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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409275
Report Date: 08/19/2022
Date Signed: 08/19/2022 05:32:37 PM

Document Has Been Signed on 08/19/2022 05:32 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:QUINTEROS, IRMAFACILITY NUMBER:
073409275
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
08/19/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
04:58 PM
MET WITH:Irma QuinterosTIME COMPLETED:
05:46 PM
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On Friday, August 19, 2022 at 4:58 PM, Licensing Program Analyst (LPA) Caroline Colson met with Irma Quinteros, Applicant for an announced subsequent prelicensing inspection. There are no children present. Mrs. Quinteros purchased a 3A40BC fire extinguisher. There is a large vent in the hallway that is blowing cool air. It appears that she has central heating. The ceiling vents didn't turn on. She will contact her local gas and electric company to determine what type of heat the home has to determine the heating source.

An exit interview was conducted. Appeal Rights were discussed.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Caroline Colson
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2022
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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