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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525408243
Report Date: 10/04/2023
Date Signed: 10/04/2023 09:00:03 AM

Document Has Been Signed on 10/04/2023 09:00 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:MEZA BAUTISTA, NANCY FAMILY CHILD CARE HOMEFACILITY NUMBER:
525408243
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6TOTAL ENROLLED CHILDREN: 6CENSUS: 3DATE:
10/04/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Nancy Meza BautistaTIME COMPLETED:
09:05 AM
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Licensing Program Analyst (LPA), Mendez conducted a case management facility inspection on 10/4/23 at 8:22 AM. This inspection was in response to an application for increased capacity. The application was received by the Department on 2/21/23. The licensee requested a capacity increase to 14 children.

LPA toured the facility's indoor and outdoor areas. The on limits areas of the home are the living room, kitchen and bathroom one, all other rooms have been made inaccessible using child safe knob covers. The children use the back yard as the outdoor play area, and it is fully fenced. There were no pools or other bodies of water observed in the yard. The LPA reviewed the staff ratio for a large license and the licensee acknowledged she understood the ratio requirements. The LPA also reviewed the Safe Sleep requirements with provider. Licensee's CPR/First Aid expires 11/19/23.

Local fire authority approved fire clearance on 09/22/23.

As of today’s date, 10/4/2023, the capacity increase request is granted. An exit interview was conducted with licensee.

SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
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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