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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198014542
Report Date: 12/07/2022
Date Signed: 12/07/2022 10:03:41 AM

Document Has Been Signed on 12/07/2022 10:03 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, 1000 CORPORATE CNTR DR. 200-B
MONTEREY PARK, CA 91754
FACILITY NAME:CISNEROS FAMILY CHILD CAREFACILITY NUMBER:
198014542
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 1DATE:
12/07/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Sandra Cisneros, LicenseeTIME COMPLETED:
10:20 AM
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On December 7, 2022, Licensing Program Analyst (LPA) Monique Ayala conducted a case management - licensee initiated inspection. A COVID-19 risk assessment was conducted prior to entering the facility. The home is currently licensed for 8 children and a request for a capacity of 14 children was received. All areas identified on the facility sketch were toured. Hours of operation are Monday through Friday 4:30am to 7:00pm and Saturday from 9am to 6pm.

The facility has requested an increase of capacity from 8 to 14 on 11/15/2022. Fire clearance was granted on 11/19/2022. Capacity Increase will be granted, pending final file review. License will be amended to reflect new capacity of fourteen (14) children. Increase is contingent upon a Licensing Program Manager review and approval.

The day care area is provided in living room, dinning room, restroom located on the left side of the hallway, frot yard and rear yard. Infants will sleep in the living room in playpens. Parents/guardians and children will enter through the main door for drop off and pick up.

The LPA inspected the facility and found the facility to be clean and safe. Telephone service was verified. Heating, lighting, and ventilation are adequate. LPA observed age appropriate toys and materials.

LPA reviewed infant safe sleep regulation and ratios with licensee. A copy of the Safe Sleep Regulation was provided to the licensee along with LIC9227. LPA provided recall website, https://www.cpsc.gov/Recalls



An exit interview was conducted, a copy of this report along with Notice of Site Visit was provided to the licensee.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2022
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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