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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619913
Report Date: 08/19/2021
Date Signed: 08/19/2021 01:14:28 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:FONSECA, NATALIEFACILITY NUMBER:
343619913
ADMINISTRATOR:FONSECA, NATALIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 213-7545
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:14CENSUS: 7DATE:
08/19/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Cristal Avila Lopez & Natalie FonsecaTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Gagandeep Singh met with the Helper, Cristal Avila Lopez, for an inspection of plan of correction. Purpose of the inspection was explained. Licensee arrived at the facility during the inspection. During the inspection today, there are seven children in care with the two helpers and the licensee.

During the inspection today, LPA reviewed the facility records. LPA observed an updated children roster on file. LPA observed all staff members have completed the mandated reporter training and the certificates are on file. LPA observed licensee has Consent for medical treatment form signed by the parents for each child in care. During the inspection, LPA observed all deficiencies cited on July 19, 2021 have been cleared.

No deficiency is cited today. Copy of this report is reviewed and provided to the licensee, Natalie Fonseca. Notice of site visit is posted and shall remain posted for next 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021
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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