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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 073409133
Report Date: 10/30/2023
Date Signed: 10/30/2023 03:57:45 PM

Document Has Been Signed on 10/30/2023 03:57 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, 1515 CLAY STREET, SUITE 1102
OAKLAND, CA 94612
FACILITY NAME:CABRERA BALMORI, SOFIAFACILITY NUMBER:
073409133
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 7DATE:
10/30/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:26 PM
MET WITH:Sofia Cabrera BalmoriTIME COMPLETED:
04:06 PM
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On October 30, 2023 at 3:26pm Licensing Program Analyst (LPA) Indira Loza met with Licensee Sofia Cabrera Balmori for the purpose of conducting a POC visit. Present during today's inspection was the Licensee, the Licensee's Assistnat/Mother, one infant, 5 preschool age children, and one School-Age child. LPA conducted a tour for a health and safety check.

On September 29, 2023 and October 13, 2023 the Licensee was cited CCR102416.5(e) for being out of ratio. The Licensee was in ratio today. Therefore, the citation has been cleared.

There were no deficiencies issued during todays visit.
Report and appeal right reviewed and provided to Licensee Sofia Cabrera Balmori.
Notice of Site Visit provided and must remain posted for 30 days.
SUPERVISORS NAME: Mayla Mendoza
LICENSING EVALUATOR NAME: Indira Loza
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2023
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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