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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623966
Report Date: 10/26/2021
Date Signed: 10/26/2021 09:56:03 AM

Document Has Been Signed on 10/26/2021 09:56 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:QUERO-FLORES, MARTHAFACILITY NUMBER:
343623966
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/26/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Martha Quero- FloresTIME COMPLETED:
10:00 AM
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On October 26, 2021 at 9:00 AM, Licensing Program Analyst, Tanya Washington met with Applicant Martha Quero- Flores for a second pre-licensing inspection to ensure the facility is in compliance. During today's inspection no children were present in the home.

During today's inspection the facility was toured inside and out and the following was observed:

- Applicant has posted the required posters near the entrance of the facility.
- LPA was able to see inside the shed which is used for storage, Applicant stated the shed will remain locked during day-care hours and children will not have access to it.
- LPA also observed that all hazardous cleaning compounds and chemicals were moved out of children's reach in the laundry room. Applicant was reminded to ensure that all items are stored out of children's reach in the laundry room, since there is no door on the laundry room.
- LPA observed that the Applicant moved all of the gardening tools and ladder to the off limits area behind the shed which is fenced off.

Effective today, 10/26/2021, facility is licensed as a small family child care home to serve a capacity of 6 children with no more than 3 infants or 4 infants only. Or with a capacity of 8 children: no more than 2 infants, 1 child in kindergarten or elementary school and 1 child at least age 6.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 10/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/26/2021
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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