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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503911696
Report Date: 04/21/2022
Date Signed: 04/21/2022 09:58:54 AM

Document Has Been Signed on 04/21/2022 09:58 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:CHAVEZ, LLOBANA FAMILY CHILD CAREFACILITY NUMBER:
503911696
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
04/21/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Llobana ChavezTIME COMPLETED:
10:00 AM
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On 04/21/2022 a planned second pre-licensing inspection was made today by Licensing Program Analysts (LPAs) Rene Mancinas and Ka Vang, who met with Applicant, Llobana Chavez. A tour of the home’s inside, as shown on the facility sketch was done. The areas of the home that day-care children will have access to are the living room, dining room, kitchen, family room, hallway restroom, and a portion of the backyard designated for daycare use. The remainder of the home is off limits and made inaccessible by child safety devices (i.e. safety latches and/or plastic doorknob spinners and/or safety gates). Applicant understands she is to report any changes regarding accessible/inaccessible areas. Purpose of the inspection was to ensure the following correction(s) were made:

Before Licensure the following items were needing to be corrected:

1. Applicant is to install a pool fencing which meets fencing regulation requirements. (Regulation requirements/specifics provided to applicant.

Above item was corrected and verified during today’s inspection. In-ground swimming pool fencing meets regulation requirements. Applicant understands full supervision is required when children are engaged in any water activity/play.

This home meets the description of a safe and healthy environment for children as described in Chapter 3, Division 12, Title 22 of California Code of Regulations and licensure for a capacity of up to 8 children. Licensure as a small Family Child Care Home capacity of 8 children* ages under 18 years, will be granted effective 04/22/2022. Planned hours of operation are Monday through Friday from 08:00AM - 06:00PM, and as arranged

Exit interview conducted and report was reviewed with the applicant.
This report shall be made available to the public upon request.
To order forms, etc. visit our website at www.ccld.ca.gov
SUPERVISORS NAME: Susie Fanning
LICENSING EVALUATOR NAME: Rene Mancinas
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2022
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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