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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393616949
Report Date: 03/22/2023
Date Signed: 03/22/2023 12:25:48 PM


Document Has Been Signed on 03/22/2023 12:25 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:ALVARADO, JAZARYFACILITY NUMBER:
393616949
ADMINISTRATOR:ALVARADO, JAZARYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 229-1446
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY:14CENSUS: 7DATE:
03/22/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Jazary AlvaradoTIME COMPLETED:
12:45 PM
NARRATIVE
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On 3/22/23, Licensing Program Analyst (LPA) Corina Beckby, met with Licensee, Jazary Alvarado, for the purpose of a case management visit. A review of the Facility Personnel Summary shows that all adults living and working in the home have criminal record clearances on file with Licensing. Capacity specified on the license was not met during today’s inspection. Although Licensee holds a license for a large family child care home, she was alone caring for seven children, ages 9 months, 2, 2, 3, 3, 4, & 4 years old.

LPA toured the facility, reviewed roster and other pertinent documents.

An Exit interview was conducted and report was reviewed with the licensee, Jazary Alvarado. A Notice of Site Visit was given and must remain posted for 30 days for parental review. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

LPA Beckby informed licensee, Jazary Alvarado, that this report dated March 22, 2023, documents Type A citation issued during today's case management visit, this poses an immediate risk to the health, safety, of children in care.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina BeckbyTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023
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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Document Has Been Signed on 03/22/2023 12:25 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833


FACILITY NAME: ALVARADO, JAZARY
FACILITY NUMBER: 393616949

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/22/2023
Section Cited

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If no assistant provider is present at a Large Family Child Care Home, then the licensee shall comply with the capacity requirements for a Small Family Child Care Home as specified in subsections (b) and (c).

This was evidenced by the following:
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Licensee's assistant arrived within 10 minutes to clear the deficency. LPA reviewed and discussed that when a provider is left alone, they must revert to the small FCCH ratio. Licensee wrote a declaration stating she understands the regulation. Licensee was given a visual handout without an assistant.
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Licnesee was alone caring for 6 preschool children ages 2, 2 , 4,4, 3 , 3 and 1 infant age 9 months
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regarding small FCCH ratio. LPA will return to ensure compliance.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina BeckbyTELEPHONE: (916) 263-5744
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023
LIC809 (FAS) - (06/04)
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