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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622657
Report Date: 06/27/2019
Date Signed: 06/27/2019 03:18:16 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:GOMEZ, SANDRAFACILITY NUMBER:
343622657
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
06/27/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Sandra GomezTIME COMPLETED:
03:30 PM
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Licensing program Analyst (LPA) Marissa Soto and LPAStacey Williams met with the licensee Sandra Gomez for the purpose of a capacity increase from 8 to 14 children. LPA Soto and Williams toured all areas of the home that are accessible to children, today’s census included 8 children, one infant and seven toddlers Also present during today’s inspection was Norma Zambrano, who has been finger print cleared through Community Care Licensing.
Off-limit areas include: Entire second floor, Garage, Kitchen, and South Side of the backyard. Licensee acknowledged that children may never enter these off-limit areas.

LPA observed a current roster of the enrolled children and fire drill log The Fire Safety Inspection Clearance has been received from the Cosumnes Fire Department, Elk Grove, CA and the home has been cleared for up to 14 children. In the areas that were evaluated, no deficiencies were observed at the time of the visit. Capacity increase is approved.

Effective today 06/27/2019 LPA Soto 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 old.

Licensee acknowledges that when there is no assistant present, facility will revert back to the small capacity. Licensee acknowledges that children residing in the home under the age of 10 years shall be included in capacity.

In the areas that were evaluated, no deficiencies were observed. Capacity increase was granted for a Large Family Child Care Home, exit interview conducted and Notice of Site Visit posted.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Marissa SotoTELEPHONE: (916) 926-9488
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2019
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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