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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493009999
Report Date: 09/26/2024
Date Signed: 09/26/2024 05:44:50 PM

Document Has Been Signed on 09/26/2024 05:44 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:CUEVAS, DIANA FCCHFACILITY NUMBER:
493009999
ADMINISTRATOR/
DIRECTOR:		CUEVAS, DIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 774-2318
CITY:PETALUMASTATE: CAZIP CODE:
94954
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
09/26/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Diana CuevasTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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A case management inspection was made to the facility by Licensing Program Analyst (LPA) Leticia Rosales-Meza at the request of the Licensee to inspect and approve previously designated "off-limits" areas of the home for child care use. The rooms designated as “kitchen, dining room, living room, and backyard on the facility's floor plan. There are no other changes to the facility's interior floor plan. LPA inspected and approved these areas for child care use. During today's inspection, LPA also inspected the backyard where there is an in-ground pool. There are alarms installed on the sliding doors in the family room and kitchen. The sliding door in the family room is also latched and bolted on top of sliding door. LPA observed the self-latched gate of the pool and an alarm is installed. The meets regulation requirements. The backyard patio is approved for day care use. An updated floor sketch has been submitted to the Department.

During today's inspection visit, there were four children being supervised by the licensee.

Notice of Site Visit shall be posted for 30 days from today's inspection.

There were no Title 22 deficiency cited during today's inspection.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE: DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/26/2024
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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