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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622373
Report Date: 08/11/2023
Date Signed: 08/11/2023 09:43:32 AM


Document Has Been Signed on 08/11/2023 09:43 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:GODINEZ, JUANITAFACILITY NUMBER:
343622373
ADMINISTRATOR:GODINEZ, JUANITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 230-6190
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:14CENSUS: 6DATE:
08/11/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Juanita GodinezTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPAs) Jennie Tedlos and Corina Beckby met with the Licensee Juanita Godinez for the purpose of a case management visit. LPA observed the Licensee and her Assistant, caring for 6 children including 2 infants.

Licensee stated and verified that an infant in care turned 2 years old and has one infant that is turning 2 at the end of the month, which puts her in ratio. Licensee showed LPAs the child roster showing all the children in care. The Licensee has 3 infants enrolled and 11 children enrolled total. LPA verified that Licensee is in ratio and has made the proper changes needed to ensure compliance. LPA cleared the Deficiency.

An Exit interview was conducted, and the report was reviewed and provided to Licensee. LPAs discussed and provided Appeal Rights to Licensee. LPAs posted the Notice of Site Visit and Licensee acknowledges it must remain posted for 30 days. A Failure to comply with posting requirements shall result in an immediate civil penalty of $100
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 215-3003
LICENSING EVALUATOR NAME: Jennie TedlosTELEPHONE: 916-263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2023
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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