Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 233007628
Report Date: 03/17/2016
Date Signed: 03/17/2016 04:02:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:ALVAREZ, MARIA(ANGELICA) FCCHFACILITY NUMBER:
233007628
ADMINISTRATOR:ALVAREZ, MARIA (ANGELICA)FACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 513-0520
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY:14CENSUS: 4DATE:
03/17/2016
TYPE OF VISIT:Annual/RequiredUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Maria (Angelica) AlvarezTIME COMPLETED:
04:20 PM
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LPA Leticia Rosales-Meza conducted a Annual/Required visit today for the purpose of monitoring compliance with Title 22 Regulations. Present in the home are four older day care children between the ages 2 to 5. The home was inspected inside and out. Services are provided Sunday through Saturday 5:00 AM-9:00 PM. Main day care areas continue to be the living room, kitchen, hallway bathroom, bedroom #1 will be used for napping (only), and "play" room next to kitchen. "Off" limits areas are bedrooms #2, #3, and garage. There are door knob covers to prevent access to off limits areas. Toxins and cleaning detergents are inaccessible to children. The children's bathroom is free of toxins. Outdoor play is in the back yard and is fenced. Fire extinguisher is located in the kitchen and is charged. Smoke detector in the hallway is in working order. Pediatric CPR and First Aid cards expire 02/2017 for Maria (Angelica), Sergio Guzman, and Hector Guzman. Family pets are a Dachshund Mix dog named, "Chocolate", and there are several pigeons that are kept in a very large covered cage located in the backyard. Licensee states the dog's shot records are current. There is no pools, spas, hot tubs, fish ponds, or similar bodies of water.

Children files are reviewed and complete. The facility roster is complete and up to date. Required information to be posted in the family child care home include the License (LIC 203), Emergency Disaster Plan (LIC 610A), Earthquake Preparedness Checklist (LIC 9148), and Parents' Rights Poster (PUB 394). These forms are posted in the day care space by the front door and are easily seen by parents and the public. Forms/Records to Keep in your Family Child Care Home (LIC 311D) is reviewed. Emergency drills are to be conducted and documented two times a year. The most recent drill was on December 22, 2015.

The home meets licensing standards, no deficiencies are cited today.

NOTICE OF SITE VISIT POSTED TO REMAIN POSTED FOR 30 DAYS
SUPERVISOR'S NAME: Alexis HollonTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Leticia RosalesTELEPHONE: (707) 588-5061
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2016
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2016
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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