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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622553
Report Date: 03/09/2020
Date Signed: 03/09/2020 09:22:57 AM

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:REVELES-MEDINA, MARIA & ANGELES, JR. JESUSFACILITY NUMBER:
343622553
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
03/09/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:42 AM
MET WITH:Maria Reveles-MedinaTIME COMPLETED:
09:30 AM
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On 03/09/2020 at 8:42 AM Licensing Program Analyst (LPA) Jeevun Birk-Miller conducted an unannounced case management inspection and met Licensee, Maria Reveles-Medina. During the inspection the licensee's assistant, children, and two daycare children were present at the facility. The purpose of today's visit was for an increase in capacity. Licensee has requested a capacity increase to 14 children. A fire clearance has been approved by the local Consumes Community Services District fire marshal. LPA Birk-Miller observed a working 3A40BC fire extinguisher and a working smoke and carbon monoxide detector. LPA observed the newly installed fire pull system. Licensee stated there are no new residents in the home since being licensed and all adults who require fingerprint clearances have received the required clearance. A health and safety inspection was done of the inside and outside of the home in areas accessible to children in care.

The Fire Marshall has inspected and approved the fire clearance for the large family child care home effective March 03, 2020.

Effective today 03/09/2020, LPA is granting a license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years. When there is no assistant present, the facility will revert back to the small capacity.

An exit interview was conducted. Notice of Cite Visit posted and no deficiencies cited.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 03/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2020
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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