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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623671
Report Date: 12/28/2021
Date Signed: 12/28/2021 10:35:49 AM

Document Has Been Signed on 12/28/2021 10:35 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:HUIZAR, MARIAFACILITY NUMBER:
343623671
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
12/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Maria HuizarTIME COMPLETED:
10:40 AM
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On 12/28/21 Licensing Program Analyst (LPA) Fabiola Diaz met with licensee Maria Huizar for unannounced annual inspection. However, licensee explained she hasn't had day care children since sometime August of this year and currently has no day care children enrolled due to the pandemic. Licensee explained that she is currently working outside of the facility. Licensee provided LPA with an inactive request form during today's visit as well. LPA explained the conditions on the LIC9211 form. LPA observed that licensee fees are current. LPA informed licensee that licensee will need to inform the Department before going back Active. Inactive Form LIC9211 requested to go inactive from 12/29/21 to 12/29/22. LPA approved the LIC9211.

No deficiencies were cited on today's date. A Notice of Site Visit was provided to licensee. This report was reviewed with licensee.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Fabiola Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2021
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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