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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618696
Report Date: 03/08/2023
Date Signed: 03/08/2023 12:20:51 PM

Document Has Been Signed on 03/08/2023 12:20 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:RODRIGUEZ, TINAFACILITY NUMBER:
343618696
ADMINISTRATOR:RODRIGUEZ, TINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 271-6040
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
03/08/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Tina RodriguezTIME COMPLETED:
01:00 PM
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On 03/08/2023, Licensing Program Analyst Katy Maestas (LPA) conducted a field visit to the Family Childcare Home (FCCH) for the purpose of a case management inspection. LPA arrived at the FCCH and was met by Licensee Tina Rodriguez (L1). LPA disclosed the purpose of the inspection and was granted entrance into the FCCH. LPA toured the FCCH and observed 2 infants and 4 preschool aged children in care. Also present in the FCCH was L1's adult daughter. LPA accessed Guardian and assessed that all required adults were background cleared.

L1 initiated the field visit to make her backyard On-Limits and to have her newly constructed pool inspected. LPA conducted a health and safety inspection of the backyard and no hazards or violations were observed. LPA walked the perimeter of the backyard and ensured that the yard is fully enclosed with a sturdy fence. LPA measured the fence, which is fully surrounding the pool, at exactly 5 feet high with a gap of less than 4 inches from the ground.The fence did not obscure the view of the pool, and the entrance gate to the pool swings away from the pool. LPA observed the gate to be both self-closing and self-latching.

As of today, 03/08/2023, the backyard will be on-limits and accessible to children in care. The Off-Limits areas of the FCCH are: laundry room, entire 2nd floor, garage, pool, and backyard shed.

An exit interview was conducted and the report was reviewed with L1. Licensee Appeal Rights were provided. A Notice of Site visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Nola Maestas
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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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