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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313621717
Report Date: 05/17/2022
Date Signed: 05/17/2022 12:19:18 PM


Document Has Been Signed on 05/17/2022 12:19 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:SOTO HORWITZ, ADRIANAFACILITY NUMBER:
313621717
ADMINISTRATOR:SOTO HORWITZ, ADRIANAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 510-1662
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:14CENSUS: 12DATE:
05/17/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Adriana Soto HorwitzTIME COMPLETED:
12:30 PM
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Licensing Program Analyst Amanda Blesi arrived unannounced to clear a ratio deficiency that was cited during the annual inspection on 4/28/22. During today's inspection LPA observed 12 children in care supervised by licensee and two assistants. LPA observed licensee in ratio today and the deficiency is cleared.

Notice of Site Visit provided.
Exit interview conducted and letter of deficiency cleared was provided.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:
DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/17/2022
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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