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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153911491
Report Date: 10/11/2021
Date Signed: 10/11/2021 02:58:40 PM

Document Has Been Signed on 10/11/2021 02:58 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CHAVEZ, MITHA FAMILY CHILD CAREFACILITY NUMBER:
153911491
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
10/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Mitha Chavez TIME COMPLETED:
03:15 PM
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On 10/11/21, Licensing Program Analyst (LPA) Araceli Gibson conducted an unannounced case management - 90 day follow-up inspection. LPA was greeted by Licensee, Mitha Chavez, LPA toured of the home. Present during today's inspection was one child in care.

The purpose of today's inspection was to conduct a post-licensing 90-day follow-up. The areas of the home that are accessible to daycare children are the living room, daycare room, bathroom, kitchen, and fenced backyard. LPA observed the home to be safe and clean. No potential risks to the health and safety of daycare children were observed. Licensee stated there are on firearms in the home. No "bodies of water" are present on the premises. LPA observed a working fire extinguisher, smoke detector, and carbon monoxide indicator. Licensee is conducting and documenting fire drills every six months. Licensee maintains a current roster of the children.

LPA reviewed three children's records during today's inspection. All children's records reviewed were complete with all required licensing documentation. All adults who reside or work in the home have a criminal record clearance or exemption. There are no excluded individuals present in the home.

Days and hours of operation are Monday – Sunday, but less than 24 hours per day.

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

THIS REPORT SHALL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Araceli Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2021
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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