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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 115408454
Report Date: 05/28/2024
Date Signed: 05/28/2024 02:23:37 PM

Document Has Been Signed on 05/28/2024 02:23 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:VAZQUEZ, OFELIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
115408454
ADMINISTRATOR/
DIRECTOR:		VAZQUEZ, OFELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 884-9454
CITY:WILLOWSSTATE: CAZIP CODE:
95988
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
05/28/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:55 PM
MET WITH:Ofelia VazquezTIME VISIT/
INSPECTION COMPLETED:
02:32 PM
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On 5/28/24 at 1:55pm, Licensing Program Analyst (LPAs) Bianca Mendez and Tammy Dutra conducted a case management visit and met with licensee with Ofelia Vazquez. LPA Bianca Mendez met with licensee to determine that licensee had completed the corrections during the prelicensing inspection.


During the inspection LPA Bianca Mendez toured the facility and verfied that the licensee completed the corrections and the licensee filled in the pool with dirt.



Exit interview was conducted with applicant with Ofelia Vazquez
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 05/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/28/2024
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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