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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623943
Report Date: 06/07/2021
Date Signed: 06/07/2021 03:22:34 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:
06/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Catalina AlvaradoTIME COMPLETED:
03:30 PM
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On Monday, June 7, 2021, at approximately 2:30 PM, Licensing Program Analyst (LPA) Alize Tillery met with Applicant Catalina Alvarado for the purpose of conducting an announced Change of Location, pre-licensing inspection. During today's inspection, applicant and her two minor children were present in the home. Applicant and all other adults (husband) have criminal record clearances on file. Applicant plans to operate Monday - Friday from 7:30AM to 5:30PM. Applicant submitted proof of control of property.

A health and safety inspection was conducted inside and out of the home. The one story facility includes 2 bedrooms, 1 bathroom, kitchen/dining room area, living room/play area, front yard, fenced backyard and two garages. The off limit areas will include: the 2 bedrooms, both garages, and the back half of the backyard (that is fenced off).



There is a fireplace in the home, that will not be used, and is blocked by a large terrarium tank. Toxic and hazardous items are inaccessible to children and out of children's reach. Sharp knives are stored in the kitchen out of children's reach. Applicant will have medications stored above the refrigerator, out of children’s reach. A first aid kit, a functioning smoke detector, carbon monoxide detector and a full 2A10BC fire extinguisher were observed in the home. LPA observed all required licensing postings along with COVID19 posters.

Report continues on LIC809-C.

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

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: ALVARADO, CATALINA
FACILITY NUMBER: 343623943
VISIT DATE: 06/07/2021
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LPA discussed Unusual Incident Report requirements with applicant. Applicant is scheduled to take the required Preventative Health and Safety course on 6/10/2021. Applicant has a current EMSA certified CPR and First Aid card which expires 01/2023. Applicant stated there are no weapons in the home and there are no bodies of water on the premises. Applicant understands that prior to making alterations or additions to the home or grounds, he/she shall notify the Department of the proposed changes.

Applicant was encouraged to visit the Department’s website at www.cdss.ca.gov for more information regarding child care updates, forms, regulations and legislation. LPA will email this report and Appeal Rights to Licensee. Acknowledgment of delivery of report constitutes acknowledgement of receipt, in lieu of signature.



As of today, June 7, 2021, facility is approved for a Large Family Child Care Home license for a maximum capacity (when there is an assistant present): 12 – no more than 4 infants. Capacity of 14 – no more that 3 infants, 1 child in kindergarten or elementary school and 1 child at least age 6.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Alize TilleryTELEPHONE: (916) 216-7798
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2021
LIC809 (FAS) - (06/04)
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