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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622774
Report Date: 07/15/2019
Date Signed: 07/15/2019 01:43:23 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:SILVA, ERIKAFACILITY NUMBER:
343622774
ADMINISTRATOR:SILVA, ERIKAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 366-8571
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:14CENSUS: 3DATE:
07/15/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Erika SilvaTIME COMPLETED:
02:05 PM
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Licensing Program Analysts (LPAs) Marissa Soto and LPA Stacey Williams met with Licensee Erika Silva for unannounced visit for the purpose of a room approval for on limits. LPA Soto and Williams toured all areas of the home that are accessible to children, today’s census included two infants and 1 toddler. Also present during today’s inspection was daughter and assistant Cristal Zeas and adult daughter Michelle Zeas, who has been finger print cleared through Community Care Licensing.


Off-limit areas include: Entire second floor, and downstairs bathroom, laundry room. Licensee acknowledged that children may never enter these off-limit areas.

In the areas that were evaluated, no deficiencies were observed at the time of the visit. Formal dinning room and downstairs bedroom are approved effective today 07/15/2019..

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

DATE: 07/15/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2019
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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