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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911422
Report Date: 10/06/2021
Date Signed: 10/06/2021 01:01:32 PM

Document Has Been Signed on 10/06/2021 01:01 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:PADILLA, LORENA FAMILY CHILD CAREFACILITY NUMBER:
503911422
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
10/06/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Lorena PadillaTIME COMPLETED:
01:15 PM
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On October 6, 2021 Licensing Program Analyst (LPA) Kari McWilliams conducted an unannounced case management visit per Licensee's request regarding the approval to use the downstairs bedroom #2 as another room in her in home child care facility; primarily used as a napping area for infants. LPA toured the facility and a census was taken. LPA inspected the room and found there to be no health and safety risks to children in care. LPA granted the use of bedroom #2. Licensee provided LPA with an updated facility sketch to include bedroom #2.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies are cited.
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Kari McWilliams
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2021
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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