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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629129
Report Date: 07/06/2021
Date Signed: 07/06/2021 12:33:48 PM

Document Has Been Signed on 07/06/2021 12:33 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, 7575 METROPOLITAN DR., STE 110
SAN DIEGO, CA 92108
FACILITY NAME:THEANO, CELINE FAMILY CHILD CAREFACILITY NUMBER:
376629129
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
07/06/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Celine TheanoTIME COMPLETED:
12:00 PM
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On 7/6/21 at 11:30am, Licensing Program Analyst (LPA), Martha Malane arrived at the facility to conduct a second pre-licensing inspection and met with applicant, Celine Theano. The purpose of today's second pre-licensing inspection is to inspect the newly installed pool fence surrounding the pond in the backyard.

The pool fence measured 5 feet in height and LPA observed the fence to surround the pond and the gate was locked. At the time of the inspection, LPA observed the gate to be self-closing, self-latching and swings away from the pond. Applicant stated she or a staff member will check the pool fence and gate each morning prior to children's arrival to ensure the gate is closed and locked and the fence is secure. During the inspection, LPA took pictures of the pool fence and the pool gate.

An exit interview was conducted with applicant. The LIC809 report was discussed and provided. A small family childcare license will be issued effective, 7/6/2021. LPA informed applicant once the license is received it is to be posted in a prominent place in the home.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2021
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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