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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334845903
Report Date: 08/04/2023
Date Signed: 08/07/2023 09:01:27 AM

Document Has Been Signed on 08/07/2023 09:01 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, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:SANGANI FAMILY CHILD CAREFACILITY NUMBER:
334845903
ADMINISTRATOR:SANGANI,DAXAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(208) 854-9490
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
08/04/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:41 PM
MET WITH:Daxa Sangani, LicenseeTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Elyse Jones and Blanca Ruiz arrived at the facility to conduct a Case Management inspection in response to the receipt of an
Unusual Incident Report (UIR) from the facility dated July 12, 2023. A facility tour was given and census were taken.

More time is needed to obtain additional information pertaining to the reported incidents. Upon completion the findings will be shared with the Licensee.

A notice of site visit was given and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with Daxa Sangani, Licensee.

SUPERVISORS NAME: Aaron Ross
LICENSING EVALUATOR NAME: Elyse Jones
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2023
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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