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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304314143
Report Date: 07/13/2023
Date Signed: 07/13/2023 11:58:37 AM

Document Has Been Signed on 07/13/2023 11:58 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, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:SARMIENTO, ELISABETHFACILITY NUMBER:
304314143
ADMINISTRATOR:SARMIENTO, ELISABETHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(714) 737-4012
CITY:ANAHEIMSTATE: CAZIP CODE:
92801
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 6DATE:
07/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Elisabeth Sarmiento, LicenseeTIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPAs) Stacy Torrence and Aiddee Nunez conducted an unannounced Case Management inspection at the Family Childcare home to ensure licensee is in compliance with Title 22 regulations. LPA met with Licensee Elisabeth Sarmiento who guided analyst on a tour of the facility. During today’s inspection, LPAs observed six children in the day care activity area. During today’s inspection, there were no other adults present.

During today’s inspection, there were no deficiencies observed or cited, the facility was in compliance with Title 22 regulations.

An exit interview was completed. The report was reviewed and discussed.

The facility representative was informed that the “Notice of Site Visit” must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The “Notice of Site Visit” must be posted on or adjacent to the door.

SUPERVISORS NAME: Thuy Ho
LICENSING EVALUATOR NAME: Stacy Torrence
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2023
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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