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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623381
Report Date: 01/27/2021
Date Signed: 01/27/2021 01:49:00 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:VELASQUEZ, AMYFACILITY NUMBER:
343623381
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 8DATE:
01/27/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Amy VelasquezTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Christopher Bello and a tele-inspection with Amy Velasquez for a Case Management Licensee Initiated inspection on 1/27/2021 using the FaceTime application. The purpose of the inspection was to add a room that was off-limits to the on-limits portion of the daycare. During today's inspection there were a total of eight daycare children including the licensee's minor child. Also present was licensee's other minor children. LPA inspected the room and observed that the room was in compliance with Title 22 regulations and Health and Safety Code. LPA approved the room for use. The off-limits areas in the home is the entire upstairs, master bedroom and garage. There were not Title 22 deficiencies at time of inspection. . An exit interview was conducted, copy of the report, Appeal Rights and Notice of Site Visit were sent to Amy via email. The Notice of Site Visit must be posted for 30 days. Amy will reply that she received the email to act as her virtual signature.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Christopher BelloTELEPHONE: (916) 862-0844
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2021
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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