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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103908522
Report Date: 05/11/2022
Date Signed: 05/11/2022 09:22:40 AM

Document Has Been Signed on 05/11/2022 09:22 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:VILLEDA, HERMELINDA FAMILY CHILD CAREFACILITY NUMBER:
103908522
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 4DATE:
05/11/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Hermelinda VilledaTIME COMPLETED:
09:30 AM
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On 05/11/2022, Licensing Program Analyst (LPA) Jeovanna Yanez conducted an unannounced case management inspection due to licensee revising her facility floor plan and making off-limit bedroom #2 accessible to children in care. LPA met with Licensee, Hermelinda Villeda. Licensee is making the bedroom #1 inaccessible to the day care children by the use of a plastic door knob cover. Master bedroom, and bedroom #3 will remain off-limits to children in care. Licensee confirmed living room, dining room, kitchen and hall bathroom are still accessible to children.

LPA inspected the facility and advised the licensee to submit an updated facility sketch documenting this change. LPA observed bedroom #2 to be free of hazards. Bedroom #2 is approved for daycare use.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the licensee, Hermelinda Villeda

SUPERVISORS NAME: Juvenal Moctezuma
LICENSING EVALUATOR NAME: Jeovanna Yanez
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2022
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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