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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 493010084
Report Date: 11/27/2023
Date Signed: 11/27/2023 02:54:00 PM

Document Has Been Signed on 11/27/2023 02:54 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, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME:MUNOZ ARREOLA, CARMEN FCCHFACILITY NUMBER:
493010084
ADMINISTRATOR:MUNOZ ARREOLA, CARMENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 889-1056
CITY:SANTA ROSASTATE: CAZIP CODE:
95404
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
11/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Migdalia DiazTIME COMPLETED:
01:55 PM
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An unannounced Case Management was conducted by Licensing Program Analyst (LPA), Leticia Rosales-Meza for the purpose of obtaining signatures and delivery an amended report of the original report dated 11/17/23. LPA met with Migdalia Diaz.
SUPERVISORS NAME: Alexis Hollon
LICENSING EVALUATOR NAME: Leticia Rosales
LICENSING EVALUATOR SIGNATURE: DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/27/2023
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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