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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622553
Report Date: 02/15/2024
Date Signed: 02/15/2024 11:10:27 AM


Document Has Been Signed on 02/15/2024 11:10 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:REVELES-MEDINA, MARIA & ANGELES, JR. JESUSFACILITY NUMBER:
343622553
ADMINISTRATOR:REVELES-MEDINA, MARIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 623-5574
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY:14CENSUS: 11DATE:
02/15/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria Reveles-MedinaTIME COMPLETED:
11:30 AM
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On 02/15/2024, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the Family Childcare Home (FCCH) and met with Licensee Maria Reveles-Medina (L1) for the purpose of a licensee initiated case management inspection. The purpose of today's visit was to change a 2nd dwelling on the property (Building B) from OFF-limits to ON-limits. LPA toured the FCCH and observed a census of 10 preschool aged children and 1 school aged child being supervised by 3 Aides. LPA accessed Guardian and determined that all required individuals subject to a background review had obtained a criminal record clearance and were associated to the license.

L1 requested that Building B be on ON-limits to conduct childcare in Building B. LPA inspected Building B in entirety. A fire clearance has been received by LPA and is on file with the Department. L1 has updated both indoor and outdoor maps. LPA has filed the maps in the facility's hard file in the Regional Office.

As of today, 02/15/2024, Building B is on-limits and accessible to children in-care. Licensee has requested to make the OFF-limit areas in Building A: Bedroom #1, Bedroom #2, Master bed and bathroom, Family Room, Laundry Room, Garage. OFF-limits areas for the outdoor space: Dog Run, Building B's backyard, Chicken Coop, Storage Shed, Shop, Garden Shed.

In the areas that were evaluated on 02/15/2024, no deficiencies were observed at the time of the inspection. This Facility Evaluation Report was reviewed and discussed with Licensee Reveles-Medina and Licensee/Appeal Rights were provided by LPA. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISOR'S NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR NAME: Katy VelazquezTELEPHONE: 916-926-9100
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024
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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