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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622096
Report Date: 12/22/2021
Date Signed: 12/22/2021 12:26:05 PM

Document Has Been Signed on 12/22/2021 12:26 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:LOZANO CRUZ, NELLYFACILITY NUMBER:
393622096
ADMINISTRATOR:LOZANO CRUZ, NELLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 441-9799
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 5DATE:
12/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Nelly Lozano Cruz TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Stacey Williams arrived at the facility for the purpose of inspecting an area of the home that was currently listed as off limits. LPA met with Licensee and her husband. LPA observed (5) five children supervised by the Licensee.

LPA toured the backyard that has a covered porch with fencing that surrounds the area. Licensee stated that the area will be utilized as an additional play space for the children. The area provides shade and 5 feet fencing all around. This space will be added as an on limits area to the license.

Exit interview conducted with Licensee, Nelly Lozano Cruz. Notice of Site visit provided.


SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Stacey Williams
LICENSING EVALUATOR SIGNATURE: DATE: 12/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/22/2021
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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