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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393617392
Report Date: 01/15/2020
Date Signed: 01/15/2020 10:37:54 AM

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:PLASENCIA, ROSALINDAFACILITY NUMBER:
393617392
ADMINISTRATOR:PLASENCIA, ROSALINDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 325-4225
CITY:MOUNTAIN HOUSESTATE: CAZIP CODE:
95391
CAPACITY:14CENSUS: 5DATE:
01/15/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:Rosalinda Plasencia TIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Stacey Williams met with licensee Rosalinda Plasencia for a case management inspection. LPA observed five children supervised by licensee and her assistant. Community Care Licensing received information pertaining to an incident that occurred in the licensee's home. LPA discussed the incident with the licensee. Based on the information received there was no indication of title 22 violations.

LPA discussed proposed safe sleep best practices and signed licensee up for childcare updates through the department's website.

Exit interview conducted and notice of site visit posted.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2020
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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