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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621193
Report Date: 09/01/2020
Date Signed: 09/01/2020 11:59:54 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:ARORA, GURMEETFACILITY NUMBER:
393621193
ADMINISTRATOR:ARORA, GURMEETFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 870-2264
CITY:LATHROPSTATE: CAZIP CODE:
95330
CAPACITY:14CENSUS: 6DATE:
09/01/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Gurmeet AroraTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Alecia Sifuentes conducted a case management tele-inspection via WhatsApp with Licensee, Gurmeet Arora due to COVID-19 State of Emergency in lieu of an on-site visit. The purpose of the inspection was to approve the backyard from "off-limit" status to "on-limit" status. The backyard was inspected and determined to be in compliance with Title 22 regulations.

As of today's date, 9/1/2020, LPA Sifuentes has approved the backyard to become "on-limits" and will change the license to reflect the change that was made.

An exit interview was conducted and the LIC809 report and updated License will be emailed to the Licensee.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2020
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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