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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313617358
Report Date: 10/21/2019
Date Signed: 10/21/2019 02:03:35 PM

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:BARAJAS, CRYSTALEFACILITY NUMBER:
313617358
ADMINISTRATOR:BARAJAS, CRYSTALEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 821-7690
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:14CENSUS: 10DATE:
10/21/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Crystale BarajasTIME COMPLETED:
02:30 PM
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LPA's Amanda Blesi and Katrina Owens arrived at the facility for the purpose of a plan of correction inspection. On October 11, 2019, licensee was sited a deficiency for being out of ratio when LPA's observed 14 children in care four of whom were infants. LPA's made an unannounced inspection today and observed 10 children in care. Four of the children were were infants. LPA observed licensee to be in compliance with Title 22 Regulations during today's inspection. Deficiency is cleared and letter of clearance was provided to licensee.


No deficiencies were cited today.
Exit interview was conducted with licensee and notice of site visit was provided.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2019
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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