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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343620505
Report Date: 12/30/2019
Date Signed: 12/30/2019 02:24:35 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:TOTS OF LOVEFACILITY NUMBER:
343620505
ADMINISTRATOR:COURTNEY WILLIAMSFACILITY TYPE:
850
ADDRESS:5619 MARCONI AVENUETELEPHONE:
(916) 689-8687
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:24CENSUS: DATE:
12/30/2019
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Desiree LunaTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Karyn Guerra met with new Director, Desiree Luna, following up on a self reported incident received to the department via fax on 12/5/2019. Census was 13 napping children supervised by 2 staff. All individuals subject to criminal background review have obtained clearance. LPA gathered documents. Director was reminded that any changes that may occur regarding the director or an employee acting in the director's absence must be reported to department within ten working days.

No regulatory violations were cited during today's inspection. An exit interview was conducted. A notice of site visit was provided and should remain posted at the facility for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 216-7796
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2019
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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