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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198019788
Report Date: 05/09/2023
Date Signed: 05/09/2023 08:42:11 AM

Document Has Been Signed on 05/09/2023 08:42 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:BALTAZAR FAMILY CHILD CAREFACILITY NUMBER:
198019788
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 2DATE:
05/09/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Yanina Baltazar, LicenseeTIME COMPLETED:
09:00 AM
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On May 9, 2023, 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 Sunday 6AM to 5:59PM.

The facility has requested an increase of capacity from 8 to 14 on 04/06/2023. Fire clearance was granted on 04/27/2023. 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, kitchen/dinning room, hallway bathroom and rear yard.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. The children/parents will enter through the front door.

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. Infants will sleep in playpens located in the living room.



The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.

An exit interview was conducted, a copy of this report was provided to licensee.
SUPERVISORS NAME: Ana Chico
LICENSING EVALUATOR NAME: Monique Jessica Ayala
LICENSING EVALUATOR SIGNATURE: DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/09/2023
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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