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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103911452
Report Date: 09/14/2021
Date Signed: 09/14/2021 09:42:25 AM

Document Has Been Signed on 09/14/2021 09:42 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CRUZ DE SEGOVIA, MARIA FAMILY CHILD CAREFACILITY NUMBER:
103911452
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
09/14/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Maria Cruz de SegoviaTIME COMPLETED:
10:00 AM
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A second announced pre-licensing inspection was conducted today by Licensing Program Analyst (LPA), Norma Lomeli. Met with Spanish-speaking Applicant, Maria Cruz de Segovia. Applicant, her husband, her adult son, her adult daughter and three minor children reside in the home.

The purpose of today's inspection is to verify that the following corrections requested were made. LPA observed the following corrections today:
  • During today's inspection, LPA observed that both gates that lead to the in-ground pool are self-latching/ self-closing and swing away from the pool.

During today's inspection, applicant made changes to her home's facility sketch. The home is a single story, five bedrooms and three bathrooms home and children will have access to the living room, dining room, kitchen and bedroom #5 and half bathroom located in bedroom #5. LPA observed that the fifth bedroom is fully renovated, there is a heating and air conditioning unit and a half bathroom. Applicant states that bedroom #5 will be utilized as the day care room. Applicant provided Fresno Regional Child Care office with building permits for bedroom #5. Off-limits rooms are made inaccessible by use of plastic doorknob covers.

Provisional License for a Small Family Day Care Home capacity of 8 children ages under 18 years will be issued for 90 days, pending receipt of the Preventive Health and Safety Training certification. Provisional license will be recommended effective September 15, 2021.

* Planned hours of operation are Monday through Friday from 6:00 AM to 6:00 PM.
SUPERVISORS NAME: Duane Matsubara
LICENSING EVALUATOR NAME: Norma Lomeli
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2021
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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