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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010558
Report Date: 02/01/2024
Date Signed: 02/01/2024 11:48:26 AM

Document Has Been Signed on 02/01/2024 11:48 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:MORENO, LETICIA FCCHFACILITY NUMBER:
493010558
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 4CENSUS: 1DATE:
02/01/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Leticia MorenoTIME COMPLETED:
11:13 AM
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A change of capacity inspection- case management inspection was made today by Licensing Program Analyst (LPA) Y. Yang. The licensee is requesting a license for a capacity of 14 children. Proof of control of property is on file. The fire clearance for the requested capacity was received by the Department on 01/30/24. Services will be available Mon- Fri 07:00 AM - 05:00 PM. The licensee understands that 24hr consecutive care is prohibited. The residence is a three bedroom/ two bathroom, single level home. There are two adults living in the home. The licensee was advised that all adults residing or working at the facility must have a criminal background clearance on file with CCLD. The licensee is aware of the immediate $100 per day civil penalty for adults working or residing in the home without a criminal record clearance.

The floor and yard plans are verified. The licensee provided proof of control of property. The children have access to the living room, kitchen, dining room, hall bathroom, rooms # 2 and #3. The "off limits" areas of the home are the master bedroom and bathroom, the garage, and bedroom #4. These areas are made inaccessible by door locks, latches, door knob covers, and/or child gates. The home appears to be clean and orderly at this time and will remain so during child care hours. There is a working telephone in the home (licensee's cell phone). The sharp knives, cleaning supplies, medicines, will be stored out of the reach of children. The licensee states there are no firearms and ammunition stored on the premises. The licensee states that poisons are not stored on the premises. The regulation that poisons are to be locked using a key or combination lock was reviewed. First Aid supplies are maintained at the facility. The children in care have access to age appropriate toys and equipment. The home is equipped with a working smoke detector, carbon monoxide detector, and a fire extinguisher rated at least 2-A 10:BC. The children have access to the fully fenced backyard and front yard. There is an above ground hot tub in the backyard with a locked hard cover. No other bodies of water were observed and none shall be added without prior approval of the Licensing agency.

The increase of capacity application for a capacity of 14 has been approved effective today's date. The exit interview has been conducted and this report has been reviewed with the licensee, Leticia Moreno. Notice of Site Visit shall be posted for 30 days.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Yang Yang
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
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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