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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 243909809
Report Date: 09/07/2021
Date Signed: 09/07/2021 05:42:34 PM

Document Has Been Signed on 09/07/2021 05:42 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:AYALA, MANUEL & DOMINICA FAMILY CHILD CAREFACILITY NUMBER:
243909809
ADMINISTRATOR:AYALA, MANUEL & DOMINICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 384-3643
CITY:MERCEDSTATE: CAZIP CODE:
95341
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
09/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:15 PM
MET WITH:Manuel and Dominica AyalaTIME COMPLETED:
05:55 PM
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On 09/07/2021 Licensing Program Analyst (LPA), Roman Iglesias conducted an unannounced case management inspection. Officer Hernandez (Badge #294) with the Merced Police Department was also present to assist in conducting a civil standby. LPA met with Licensees, Manuel and Dominica Ayala. The purpose of this inspection was to verify Licensee’s adult son, Joel Damien Ortega, was not living, or present, at the facility. Licensees were previously provided with an Order of Exclusion on 08/26/2021 informing them that Joel is excluded from having contact with day care children or being physically present at any facility licensed by the Department.

During today’s inspection, LPA was granted permission to inspect indoor/outdoor areas of the home, including bedrooms, to verify Joel was not living, or present, at the facility. LPA did not discover any belongings/items to suggest Joel resides at the facility.

Per California Code of Regulations Title 22 Division 12 Chapter 3, no deficiency is being cited today. Notice of Site Visit to be posted for 30 days.
SUPERVISORS NAME: Alice Juarez
LICENSING EVALUATOR NAME: Roman Iglesias
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2021
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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