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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313600103
Report Date: 10/27/2022
Date Signed: 10/27/2022 10:50:45 AM


Document Has Been Signed on 10/27/2022 10:50 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:BINCZEWSKI, VERONICAFACILITY NUMBER:
313600103
ADMINISTRATOR:BINCZEWSKI, VERONICAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 771-3889
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:12CENSUS: 0DATE:
10/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Veronica Binczewski - LicenseeTIME COMPLETED:
11:15 AM
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An unannounced inspection was conducted today by Licensing Program Analyst Owens and Gallo. The purpose of the inspection is to observe the operation of the facility,

Licensee stated she wanted to put her license on inactive status as of today.
LPA had licensee complete and sign the Request for Inactive Child Care Status form LIC 9211 at time of inspection.

LPA Owens also gave licensee an Application for FCCH form LIC 279. to change her capacity from a large to a small.

No deficiencies issued at time of inspection.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Katrina OwensTELEPHONE: 916-263-6280
LICENSING EVALUATOR SIGNATURE:
DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/27/2022
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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