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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623034
Report Date: 10/13/2020
Date Signed: 10/14/2020 09:22:11 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:VALENZUELA, TRACINAFACILITY NUMBER:
343623034
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 2DATE:
10/13/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Tracina ValenzuelaTIME COMPLETED:
05:20 PM
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On 10/13/2020 at 5:00 PM Licensing Program Analyst (LPA) Jeevun Birk-Miller conducted a case management tele-inspection via Facetime with Licensee, Tracina Valenzuela in lieu of conducting an on site inspection due to the COVID-19 pandemic. The purpose of the inspection was for approval of an in ground pool located in the Licensee's backyard.

Licensee recently installed the in ground pool. Licensee has ensured pool fencing requirements are met. LPA toured the backyard and observed a mesh fence installed around the pool. The mesh fencing is attached to the backyard's existing wood fencing. LPA had the Licensee measure the base of the fence to top of the fence. The base to the top of the fencing measured above 5 feet. The fencing does not obstruct the view of the pool. Licensee demonstrated the fence gate closure which is self closing/latching and swings away from the body of water. Licensee pulled on the fencing around the pool to show that it was securely placed.

As of today the backyard will be placed back onlimits now that the construction of the pool has been completed.

Based on today's inspection, 10/13/2020, Licensee's pool fencing for the in ground pool meets title 22 regulation requirements. An exit interview was conducted and a notice of site visit will be emailed to Licensee to post in the facility.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Jeevun BirkTELEPHONE: (916) 917-6078
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2020
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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