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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 525408245
Report Date: 03/05/2025
Date Signed: 03/05/2025 12:57:43 PM

Document Has Been Signed on 03/05/2025 12:57 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, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:DOMINGUEZ, MARIA FAMILY CHILD CARE HOMEFACILITY NUMBER:
525408245
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
03/05/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Maria DominguezTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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An unannounced case management inspection was conducted today at 12:20pm by Licensing Program Analyst (LPA), Bianca Mendez. LPA met with licensee Maria Dominguez in response to the licensee’s request for an increase of capacity to 14. An approved fire inspection was received on 2/24/25. The licensee has met the requirement for at least one year of experience. A copy of the staffing ratio requirements was provided and discussed with the licensee. The licensee acknowledged she understood the ratio requirements and has an assistant with the required documentation on file. The licensee understands that an assistant provider under the age of 18 cannot be left alone without an adult on the premises.

The facility operates Monday-Friday, 7:00am to 5:00pm. The residence is a 3 bedroom/2 bath one story home. The home and yard were toured, and the facility sketch was verified. The following areas will be off limits to children: 2 bedrooms and garage.These areas have been made inaccessible by doorknob covers and lock. The home is equipped with a working smoke detector and fire extinguisher rated at least 2A10BC. The children will use the backyard as the outdoor play area. The backyard is completely fenced. There is no pool, spa, pond, fountain, or any other body of water on the premises.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: DOMINGUEZ, MARIA FAMILY CHILD CARE HOME
FACILITY NUMBER: 525408245
VISIT DATE: 03/05/2025
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Based on the space/accommodations available at this facility and the fire marshal granting their approval on 2/24/25 for the 14 children, the capacity increase request is granted. LPA will process this capacity increase and mail an updated license to reflect this capacity change to 14 children. An exit interview was conducted with licensee Maria Dominguez

Notice of Site Visit was given to licensee to post for 30 days.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Bianca Mendez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC809 (FAS) - (06/04)
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