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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573615888
Report Date: 05/15/2024
Date Signed: 05/15/2024 01:39:07 PM


Document Has Been Signed on 05/15/2024 01:39 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:PALAFOX, EVAFACILITY NUMBER:
573615888
ADMINISTRATOR:PALAFOX, EVAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 321-9690
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95605
CAPACITY:14CENSUS: 6DATE:
05/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:Eva PalafoxTIME COMPLETED:
02:00 PM
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Eva Palafox is Spanish speaking. Licensing Program Analyst (LPA) Corina Beckby spoke with Licensee in Spanish, and translated the conversation to English below.

Licensing Program Analyst (LPA) Corina Beckby met with Eva Palafox to deliver an amended report.

LPA toured the facility and observed the care and supervision of children. Licensee was out at the time of visit and a cleared assistant was supervising 1 preschoolers, 1 school ager and 2 infants. Licensee returned after 3 mintues, with 1 school ager and 1 preschooler.

Exit interview was conducted. A Notice of Site Visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Corina BeckbyTELEPHONE: (916) 591-1072
LICENSING EVALUATOR SIGNATURE:
DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/15/2024
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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