<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 485408079
Report Date: 08/25/2022
Date Signed: 08/25/2022 10:10:03 AM

Document Has Been Signed on 08/25/2022 10:10 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:VALENZUELA, MIREYA FAMILY CHILD CARE HOMEFACILITY NUMBER:
485408079
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 3DATE:
08/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:49 AM
MET WITH:Mireya ValenzuelaTIME COMPLETED:
10:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Glenn Ouye met with licensee Mireya Valenzuela to conduct a capacity increase inspection. The application to go from a small to a large family child care home was received on July 28, 2022. The approved fire clearance was received by the department on August 10, 2022. A copy of the fire clearance was given to the licensee.

The licensee uses her living room and garage as the main indoor on limits area for child care. The garage is a finished garage. The fire inspector indicated on the fire clearance that the garage can be used for child care but the facility may not use the garage for the children to sleep in. The licensee will use the living room location for children to sleep

The facility has a functioning smoke and carbon monoxide detector and a fire extinguisher rated at 2A10BC.

LPA Ouye provide the licensee with safe sleep regulations, sleep log and the infant sleep plan in the event that the licensee enrolls an infant.

The facility is approved to operate as a large effective August 26, 2022. The updated license will be sent to the licensee.

No deficiencies observed during the visit.
SUPERVISORS NAME: Leslie Lepori
LICENSING EVALUATOR NAME: Glenn Ouye
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1