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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 304205597
Report Date: 01/03/2020
Date Signed: 01/03/2020 09:41:07 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 750 THE CITY DRIVE, SUITE 250
ORANGE, CA 92868
FACILITY NAME:LENZINI, JEANETTEFACILITY NUMBER:
304205597
ADMINISTRATOR:LENZINI, JEANETTEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(562) 594-0247
CITY:LOS ALAMITOSSTATE: CAZIP CODE:
90720
CAPACITY:14CENSUS: 2DATE:
01/03/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Jeanette Lenzini, LicenseeTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Yesenia Villa conducted an unannounced case management incident inspection on this day. LPA Villa was greeted by Licensee Jeanette Lenzini, there were two children present upon arrival. The facility was observed to be within ratio. A review of the Facility Personnel Report Summary on this date indicates all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions.

LPA Villa conducted an interview with a child that was not present during the previous visit conducted on 10/24/19. The investigation for the self-reported unusual incident is on going. Due to insufficient information this investigation will need further investigation.

An exit interview was conducted with Licensee Jeanette Lenzini and a notice of site visit was posted on this day. Licensee was advised that failure to post notice of site visit will result in a $100.00 civil penalty fee. Appeal rights were issued and explained.
SUPERVISOR'S NAME: Judy HansonTELEPHONE: (714) 703-2807
LICENSING EVALUATOR NAME: Yesenia VillaTELEPHONE: (714) 293-9465
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2020
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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