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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543911532
Report Date: 10/14/2021
Date Signed: 10/14/2021 01:54:01 PM

Document Has Been Signed on 10/14/2021 01:54 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:ALVA, EVANGELINA FAMILY CHILD CAREFACILITY NUMBER:
543911532
ADMINISTRATOR:ALVA, EVANGELINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 940-0501
CITY:TULARESTATE: CAZIP CODE:
93274
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
10/14/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Evangelina AlvaTIME COMPLETED:
02:00 PM
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On 10/14/2021 a planned second pre-licensing inspection was made today by Licensing Program Analyst (LPA) Rene Mancinas, who met with Applicant, Evangelina Alva. A tour of the home, inside and outside, as shown on the facility sketch was done. Areas that will be accessible to children in care include the living room and hallway bathroom. The backyard is off limits. Applicant understands she is to report any changes regarding accessible/inaccessible areas. Purpose of the inspection was to ensure the following correction(s) were made:

Before Licensure the following items are to be corrected to avoid the application form being withdrawn:

1. Applicant needs to either, remove all hazardous items in the bathroom, or put them out of children's reach.

2. Applicant needs to install a child safety gate to make her kitchen off-limits to day-care children.

Applicant has corrected above pending issues. LPA verified during today’s inspection.

This home meets the description of a safe and healthy environment for children as described in Chapter 3, Division 12, Title 22 of California Code of Regulations and licensure for a capacity of up to 14 children. Pending a final review of your application, licensure as a Large Family Child Care Home capacity of 14 children* ages under 18 years, will be recommended effective 10/18/2021. Planned hours of operation are Monday through Friday from 06:00AM - 06:00PM, and as arranged.

Exit interview conducted and report was reviewed with the applicant.
This report shall be made available to the public upon request.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Rene Mancinas
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2021
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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