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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623759
Report Date: 05/23/2022
Date Signed: 05/23/2022 02:11:53 PM


Document Has Been Signed on 05/23/2022 02:11 PM - It Cannot Be Edited

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:IBARRA, AMELITAFACILITY NUMBER:
343623759
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: DATE:
05/23/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Amelita IbarraTIME COMPLETED:
11:30 AM
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On May 23rd, 2002, LPA Pascual met with licensee Amelita Ibarra for the purpose of an announced fire clearance inspection for a capacity increase. Upon arrival there was an assistant with the licensee and three children.

LPA toured the facility's on limit areas and confirmed the changes were made that the fire department requested.
LPA verified the fire clearance before implementing a large family clearance.


Licensee will begin to operate as a large family childcare effective today, May 23rd, 2022.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Michelle PascualTELEPHONE: (916) 704-7665
LICENSING EVALUATOR SIGNATURE:
DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/23/2022
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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