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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010251
Report Date: 09/22/2023
Date Signed: 09/22/2023 10:01:56 AM

Document Has Been Signed on 09/22/2023 10:01 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:FAIZIAR, MARIA FCCHFACILITY NUMBER:
483010251
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
09/22/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maria FaiziarTIME COMPLETED:
10:15 AM
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Licensing Program Analysts(Glenn Ouye and Selena Mariani arrived unannounced to conduct a capacity increase case management visit. There are currently five children in care during the inspection. The application for the capacity increase was received on August 17, 2023. The approved fire clearance was approved on August 31, 2023.

Capacity limits, safe sleep and staffing requirements were discussed with the licensee. There is a functional smoke/carbon monoxide detector and a charged fire extinguisher in the facility. The fire pull station is located in the living room.

The facility is approved to operate as a large effective September 22, 2023.

No deficiencies during time of visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2023
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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