<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 274416758
Report Date: 04/15/2022
Date Signed: 04/19/2022 09:41:07 AM

Document Has Been Signed on 04/19/2022 09:41 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, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:FABIAN ELIZALDE, MARIAFACILITY NUMBER:
274416758
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/15/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:Maria Elizalde Fabian TIME COMPLETED:
02:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA) Elizabeth Larios conducted a Pre-Licensing inspection. LPA met with the Applicant Maria and explained the nature of today's inspection. The applicant and spouse are the only adults who were present in the home. The applicant recently acquired a firearm, and notified LPA.

The LPA toured the home during today's inspection. The off limit areas inside the home are: all bedrooms, one bathroom located in Master bedroom, and attached garage. Off limit areas outside the home are: none. The firearm is housed on a off limit bedroom. The firearm is stored in a locked gun safe. The ammunition is stored separately in a locked safe. LPA reviewed the importance of firearm safety with the applicant. LPA explained that firearms and other items which could pose a danger if readily available to children shall be stored where they are inaccessible to children. Storage areas for firearms and other dangerous weapons shall be locked. In lieu of locked storage of firearms, the applicant may use trigger locks or remove the firing pin. Firing pins shall be stored and locked separately from firearms. Ammunition shall be stored and locked separately from firearms. The applicant states she agrees to follow firearm safety in the home.


No deficiencies cited, exit interview conducted with applicant and a copy of this report was provided.
SUPERVISORS NAME: Joel Segura
LICENSING EVALUATOR NAME: Elizabeth Larios
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1