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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623943
Report Date: 06/04/2021
Date Signed: 06/07/2021 12:38:12 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:ALVARADO, CATALINAFACILITY NUMBER:
343623943
ADMINISTRATOR:ALVARADO, CATALINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 870-3711
CITY:SACRAMENTOSTATE: CAZIP CODE:
95838
CAPACITY:14CENSUS: DATE:
06/04/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Catalina AlvaradoTIME COMPLETED:
02:30 PM
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*NOTE: Due to Covid-19 and DPH guidelines on social distancing, a Tele-visit via FaceTime was conducted.*

Licensing Program Analyst (LPA) Alize Tillery met with Applicant Catalina Alvarado for an announced Case Management visit. During today's visit, only the applicant was present. LPA observed all required postings, a functioning smoke detector, carbon monoxide alarm, and a first aid kit located in the kitchen. All lower cabinets have child proof locks. Children's medications will be kept above the refrigerator out of children's reach.

This is a one story home that includes 2 bedrooms, 1 bathroom, kitchen/dining room area, living room/play area, front yard, fenced backyard and a garage. The off limit areas will include: the 2 bedrooms, the garage, and the back half of the backyard (that is fenced off). LPA and Applicant discussed toxic and hazardous items and to ensure they are out of children's reach. There is a fireplace in the home that is secured by a metal gate.

At this time, applicant is not approved for the change of location license. Applicant is not fully moved into the home. LPA and Applicant will schedule another time to conduct a pre-licensing visit.

This report was reviewed with Applicant. Acknowledgement of delivery will constitute acknowledgement of the report in lieu of a signature.

SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2021
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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