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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393621494
Report Date: 04/15/2021
Date Signed: 04/15/2021 08:06:30 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:GARCIA, ANALIESEFACILITY NUMBER:
393621494
ADMINISTRATOR:GARCIA, ANALIESEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 830-1433
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY:14CENSUS: 0DATE:
04/15/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Analiese GarciaTIME COMPLETED:
08:00 AM
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Licensing Program Analyst (LPA) Alecia Sifuentes conducted a case management tele-inspection via Facetime with Licensee, Analiese Garcia in lieu of an on-site visit due to COVID-19. The purpose of the inspection is for approval of a spa.

Licensee recently had a spa installed in the backyard of the home. Licensee has ensured the spa requirements are met. LPA observed two covers on the spa. The top cover has one locking latch that fully wraps around the spa. The second cover has six locking latches. Licensee demonstrated that all latches are functional and in good repair.

Based on today's inspection, 4/15/2021, Licensee's spa meets title 22 regulation requirements. An exit interview was conducted and the facility evaluation report will be emailed to Licensee.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR NAME: Alecia SifuentesTELEPHONE: (916) 917-9202
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021
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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