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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010605
Report Date: 09/16/2024
Date Signed: 09/16/2024 11:35:10 AM

Document Has Been Signed on 09/16/2024 11:35 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
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MOYA VILLALOBOS, MARIANA FCCHFACILITY NUMBER:
173010605
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
09/16/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Mariana Moya VillalobosTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Sebastian Phouthavong arrived to conduct a case management inspection to the facility and met with Licensee, Mariana Moya Villalobos today. The facility plans to increase the capacity to become a Large Family Child Care Home, but before the Licensee submits an an application to the department, LPA will be providing technical assistance to the facility and review the facility's daily operation.

During the inspection the home was toured inside and outside. The licensee and assistant were supervising four children and operating within the licensed capacity and ratio requirements.The facility’s operating hours are Monday – Friday, 6:45 AM – 6:00 PM. The floor plan submitted by the licensee was reviewed and verified. Off-Limit areas will be made inaccessible by door locks, latches, doorknob covers, and/or child gates.The roster of children in care was reviewed and was current. The licensee has conducted an emergency drill within the past six months; last drill was documented on 04/2024. Two children's records were reviewed at 9:37AM. Facility and personnel files were reviewed and contained required records.

LPA discussed the safe sleep regulations with licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource.

Licensee reviewed that an assistant must be present when the capacity is over 8 daycare children. Once an application for an increase of capacity has been submitted to the department, the process for an approved will be continued.
A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with the Licensee, Mariana Moya Villalobos.

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Sebastian Phouthavong
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024
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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