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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343620423
Report Date: 05/17/2019
Date Signed: 05/17/2019 02:37:52 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:ABARCA, ARETHAFACILITY NUMBER:
343620423
ADMINISTRATOR:ABARCA, ARETHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 640-7470
CITY:SACRAMENTOSTATE: CAZIP CODE:
95833
CAPACITY:14CENSUS: 9DATE:
05/17/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Aretha Abarca, LicenseeTIME COMPLETED:
02:50 PM
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Licensing Program Analysts (LPA) Joleen Kenney conducted a plan of correction visit and met with the Licensee, Aretha Abarca. The purpose of the inspection was to clear the deficiencies that were cited during the prior inspection conducted on April 16, 2019. All deficiencies have been corrected and cleared.

No deficiencies were observed or cited during today's inspection. An exit interview was conducted. Notice of Site visit was provided and posted.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen KenneyTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2019
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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