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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009806
Report Date: 07/16/2024
Date Signed: 07/16/2024 05:19:02 PM

Document Has Been Signed on 07/16/2024 05:19 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:FARFAN, EDITH FCCHFACILITY NUMBER:
483009806
ADMINISTRATOR/
DIRECTOR:		FARFAN, EDITHFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 720-8550
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 4DATE:
07/16/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Licensee Edith FarfanTIME VISIT/
INSPECTION COMPLETED:
05:20 PM
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Licensing Program Analyst (LPA) Elpidia Hernandez Torres arrived to the family child care home at 04:00PM to conduct a plan of correction visit. Licensee was previously issued a type A citation on 07/12/24 for operation over capacity. Upon arrival there were four children present ( C1-C4). LPA reviewed their files, all children have completed files. All children present have LIC 9224 acknowledgment of receipt of licensing report on file.

Licensee emailed POC to LPA on Sunday July 14 2024, and reported the facility would enroll children based on the availability they had to stay within in ratio during their schedule. Guardians will be required to enroll their child in either the AM or PM schedule.

No deficiencies were issued during todays visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 07/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/16/2024
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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