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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 483010741
Report Date: 01/22/2025
Date Signed: 01/22/2025 11:50:41 AM

Document Has Been Signed on 01/22/2025 11:50 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:CERVANTES, MAGDALENA FCCHFACILITY NUMBER:
483010741
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
01/22/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Licensee Magdalena CervantesTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst ( LPA) Elpidia Hernandez Torres arrived to the home to conduct an increase of capacity inspection. Licensee previously worked at a licensed child care center as a teacher, and submitted proof of prior employment and units required. Licensee submitted application on 12/13/2024 requesting an increase of capacity from a small (6) family child care home to a large (12) family child care home. Licensee did not receive a signed LIC 9149 with landlords consent to increase to a large (14) family child care home, as such max capacity will be 12 children, with limitations of 4 infants ( birth- 24 months) and 8 children over the age of 24 months present when Licensee and Qualified assistant is present. When Qualified assistant is not present licensee must revert back to small family child care home rules. Fairfield fire department inspected the home and granted fire clearance on 01/16/2025.

On limit areas of the home will be the living room, the kitchen, two bedrooms, the bathroom and part of the back yard. The off limit areas have been made in-accessible with door knob slip covers and/or child safety gates. LPA reviewed Safe sleep regulations; including sleep plan and sleep log requirements. LPA also reviewed the ratio requirements with licensee and provided licensee with a visual hand out.

There were no deficiencies issued during todays visit. Notice of site visit was given and must remain posted for 30 days. This day care is licensed as a Large (12) Family Child Care Home as of 01/22/2025.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Elpidia Hernandez Torres
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2025
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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