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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618809
Report Date: 01/31/2023
Date Signed: 01/31/2023 10:29:17 AM

Document Has Been Signed on 01/31/2023 10:29 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:PEREZ, VIRGINIAFACILITY NUMBER:
343618809
ADMINISTRATOR:PEREZ, VIRGINIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 399-0162
CITY:SACRAMENTOSTATE: CAZIP CODE:
95831
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
01/31/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Virginia PerezTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 9:40am for a Plan of Correction inspection regarding the deficiencies cited on LIC809D dated 1/3/2023. LPA met with Virginia Perez, also present was licensee’s mother. Present at time of inspection there were 3 children.

Based upon today’s inspection, LPA’s observed that all deficiencies are cleared as of today.

No Title 22 Deficiencies observed in the areas that were evaluated. LPA reviewed report with the director and provided copies. A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Director.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2023
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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