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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010126
Report Date: 04/13/2023
Date Signed: 04/13/2023 11:57:08 AM

Document Has Been Signed on 04/13/2023 11:57 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:LOPEZ, MARIA FCCHFACILITY NUMBER:
483010126
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
04/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Maria LopezTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Glenn Ouye met with licensee, Maria Lopez to conduct a capacity increase. The licensee submitted an application to become a large family child care home. The application was received by the department on April 3, 2023 and the approved fire clearance was received by the department on April 11, 2023.

The facility has a newly installed functioning pull station alarm. There is functioning smoke and carbon monoxide detectors. The fire extinguisher rated at least 2A10BC is mounted on the wall above the kitchen sink.

The capacity regulations were discussed with the licensee.

The facility is approved as a large family child care home effective April 13, 2023.

SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2023
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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