<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153910934
Report Date: 05/14/2021
Date Signed: 05/14/2021 01:47:11 PM

Document Has Been Signed on 05/14/2021 01:47 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:DIAZ, ELIZABETH FAMILY CHILD CAREFACILITY NUMBER:
153910934
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
05/14/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Elizabeth Diaz, Spanish SpeakingTIME COMPLETED:
02:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 05/14/2021 A planned second Prelicensing inspection was made today by Licensing Program Analyst (LPA) Daniel Alvarez, who met with Applicant Elizabeth Diaz. A tour of the home, inside and outside, as shown on the facility sketch was done. 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Before Licensure the following items are to be corrected to avoid the application form being withdrawn: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 renew her CPR and first aid training, her card expired on 11/24/2020.

Applicant has obtain a current CPR and first aid training, her card expires on 05/06/2023.

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 eight children. Pending a final review of your application, licensure as a Small Family Child Care Home capacity of eight children* ages under 18 years, will be recommended effective 05/17/2021. Planned hours of operation are Monday through Saturday from 5:00AM - 7:00PM and as arranged.

A copy of this report is to remain in the facility for public review.
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: Duane Matsubara
LICENSING EVALUATOR NAME: Daniel Q Alvarez
LICENSING EVALUATOR SIGNATURE: DATE: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1