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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623609
Report Date: 09/01/2021
Date Signed: 09/01/2021 01:31:13 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:GARCIA, NATALIEFACILITY NUMBER:
343623609
ADMINISTRATOR:GARCIA, NATALIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 203-1949
CITY:SACRAMENTOSTATE: CAZIP CODE:
95838
CAPACITY:14CENSUS: DATE:
09/01/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Natalie GarciaTIME COMPLETED:
01:45 PM
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On Wednesday, September 1, 2021, at approximately 1:30pm , Licensing Program Analyst (LPA) Alize Tillery met with Licenssee, Natalie Garcia for a plan of correction inspection regarding deficiencies cited on 07/28/2021. There were no children present during today's inspection.

LPA Tillery reviewed all children's file and observed the Consent for Medical Treatment form (LIC 627) in each.

Today, LPA Tillery is clearing citation 102417(g)(7).


During the investigation, in the areas that were observed, no deficiencies were cited. An exit interview was conducted and notice of site visit posted, Director acknowledges it will be posted for 30 days.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2021
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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