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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 376629129
Report Date: 11/17/2021
Date Signed: 11/17/2021 09:34:41 AM

Document Has Been Signed on 11/17/2021 09:34 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, 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: 3CENSUS: 3DATE:
11/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Celine TheanoTIME COMPLETED:
10:00 AM
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On 11/17/2021 at 9:05am, Licensing Program Analyst (LPA) Martha Malane conducted an unannounced case management inspection for the purpose of a capacity increase. Upon arrival, LPA met with Licensee, Celine Theano and was granted entry into the facility. There were three (3) children and one (1) helper present during the inspection. This three (3) bedroom, one (1) bathroom home was toured and inspected. Hours of operation are Monday - Friday 8:00am to 5:00pm.

A fire clearance for up to 14 children was granted 8/12/2021.

The side-yard on the south-east side of the house is off-limits. The backyard is utilized for outdoor activities. There is a pond in the backyard which is fenced and the gate swings away from the pond and self-closes and self-latches at the time of this inspection.

Background criminal record clearances were verified and discussed. A safety drill was conducted 9/13/2021. Licensee stated there are no weapons or ammunition on the premises.

LPA discussed the following with licensee: Max capacity when there is an assistant present: 12 children-no more than 4 infants (birth to 24 months). When caring for 14 children no more than 3 infants. 1 child in kindergarten and 1 child at least 6 years old. When there is no qualified assistant the capacity reverts back to the requirements from a small child care. You must notify the parents of the children in care when caring for more than 12 children.

No deficiencies cited.

An exit interview was conducted, with Licensee, Celine Theano and LPA provided the following: LIC809, LIC9213 Notice of Site Visit and Appeal Rights. A license for a large family child care is granted effective today’s date, 11/17/2021.
SUPERVISORS NAME: Tulam Vu
LICENSING EVALUATOR NAME: Martha Malane
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2021
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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