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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623034
Report Date: 07/28/2020
Date Signed: 07/29/2020 02:50:00 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:VALENZUELA, TRACINAFACILITY NUMBER:
343623034
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
07/28/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:19 AM
MET WITH:Tracina ValenzuelaTIME COMPLETED:
11:30 AM
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On 7/29/2020 at 11:19 AM Licensing Program Analyst (LPA) Jeevun Birk-Miller conducted a Tele-Inspection with Licensee, Tracina Valenzuela in lieu of conducting an on site case management inspection. The purpose of the tele-inspection was to do a health and safety inspection of the facility's backyard. The Licensee stated she was going to begin work on an in ground pool and had requested to place the backyard off-limits during construction. Effective today the backyard will be off-limits. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. The Licensee acknowledges that she must contact LPA prior to making an off-limits area on-limits and vice versa. LPA reminded the Licensee of the fencing requirements for the body of water. Licensee stated she would inform the LPA when the pool has been completed. LPA and Licensee also discussed fees.

No citations given and and an exit interview conducted.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2020
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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