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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620783
Report Date: 06/22/2021
Date Signed: 06/22/2021 01:21:56 PM

Document Has Been Signed on 06/22/2021 01:21 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:CARRANZA, NINAFACILITY NUMBER:
313620783
ADMINISTRATOR:CARRANZA, NINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 524-7084
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: DATE:
06/22/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Nina Carranza - LicenseeTIME COMPLETED:
01:45 PM
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An announced case management inspection was conducted today by Licensing Program Analyst Owens. LPA Owens met with licensee, Nina Carranza. Present at time of inspection were 10 day care children.

The purpose of the case management inspection is to observe the above ground pool. There is an above ground pool on the premises and the fencing around the pool meets Title 22, Division 12, Chapter 3 Regulations with a self closing, self latching gate that swings away from the pool . Licensee will supervise day care children at all times. There is a shed in the backyard that is locked, making the shed inaccessible to day care children.

No deficiency at time of inspection.


SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2021
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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