<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
125407310
Report Date:
04/19/2022
Date Signed:
11/14/2022 01:51:21 PM
Document Has Been Signed on
11/14/2022 01:51 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:
VELAZQUEZ, NAYELI FAMILY CHILD CARE HOME
FACILITY NUMBER:
125407310
ADMINISTRATOR:
VELAZQUEZ, NAYELI
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(707) 349-2050
CITY:
EUREKA
STATE:
CA
ZIP CODE:
95501
CAPACITY:
14
TOTAL ENROLLED CHILDREN:
14
CENSUS:
2
DATE:
04/19/2022
TYPE OF VISIT:
Case Management - Annual Continuation
UNANNOUNCED
TIME BEGAN:
02:04 PM
MET WITH:
Nayeli Velazquez
TIME COMPLETED:
02:08 PM
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
A case management was done to complete inspection toolkit.
SUPERVISORS NAME
:
Megan Aviles
LICENSING EVALUATOR NAME
:
Bianca Mendez
LICENSING EVALUATOR SIGNATURE
:
DATE:
04/19/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/19/2022
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