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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 543911581
Report Date: 09/16/2021
Date Signed: 09/16/2021 10:00:01 AM

Document Has Been Signed on 09/16/2021 10:00 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:DIAZ, ANA FAMILY CHILD CAREFACILITY NUMBER:
543911581
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 1DATE:
09/16/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Ana Diaz, Spanish SpeakerTIME COMPLETED:
10:30 AM
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On 09/16/2021 A planned second Prelicensing inspection was made today by Licensing Program Analysts (LPAs) Daniel Alvarez and Rene Mancinas, who met with Applicant Ana Diaz. A tour of the home, inside and outside, as shown on the facility sketch was done. Purpose of the inspection was to ensure the following correction(s) were made:

1 Before Licensure the following items are to be corrected to avoid the application form being withdrawn:

1. Applicant needs to bring her in-ground Koi pond fence within title 22 regulation regarding accessible bodies of water. Currently the diameter of the holes on the chain link fence are more that 1 3/4 inches. The gate is not self-closing and or self-latching, nor opens away from the body of water. Lastly the latching mechanism is not at least 54 inches from the ground.

Applicant has corrected all previous issues, pool fencing that now meets title 22 regulations.

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 eight children. Pending a final review of your application, licensure as a Small Family Child Care Home capacity of eight children* ages under 18 years, will be recommended effective 09/20/2021. Planned hours of operation are Monday through Friday from 4:30AM - 5:30PM.

A copy of this report is to remain in the facility for public review.
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: Duane Matsubara
LICENSING EVALUATOR NAME: Daniel Q Alvarez
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2021
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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