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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483009806
Report Date: 08/13/2024
Date Signed: 08/13/2024 01:28:39 PM

Document Has Been Signed on 08/13/2024 01:28 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: 10CENSUS: 10DATE:
08/13/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:37 AM
MET WITH:Licensee EdithTIME VISIT/
INSPECTION COMPLETED:
01:35 PM
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Licensing Program Analyst ( LPA) Elpidia Hernandez Torres arrived to the family child care home to review the requirements from Non-compliance conference (NCC) that took place virtually on 07/31/2024. LPA emailed the four page packet to licensee on 08/07/24 requesting a signature on page 3,4,and 5 of the packet. LPA did not receive the signed documents back.

LPA printed and reviewed the packet and explained to the licensee a copy of the packet is required to be given to the guardians of children currently enrolled and the form LIC 9224 is required to be on file for all children as receipt their guardians have received a copy of the report.

Per the NCC report, licensee was given 10 days to review the regulations and submit certification the regulations were reviewed and understood.

LPA reminded licensee of the ratio requirements and the importance of the age of each child when more than 8 children are in care.

LPA reviewed the report with licensee, there were no deficiencies issued during today’s visit. Notice of site visit was given and must remain posted for 30 days.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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