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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618891
Report Date: 04/18/2024
Date Signed: 04/18/2024 02:24:04 PM

Document Has Been Signed on 04/18/2024 02:24 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CALDERON, JACQUELINEFACILITY NUMBER:
343618891
ADMINISTRATOR/
DIRECTOR:		CALDERON, JACQUELINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 534-5152
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
04/18/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Jacqueline CalderonTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On April 18th, 2024 Licensing Program Analysts (LPAs) Mandie Goodwin and Fabian Schwartz met with Licensee Jacqueline Calderon for the purpose of an unannounced Plan of Correction visit. Licensee's assistant was also present in the home. All individuals subject to criminal background review have received clearances. Facility was previously issued a citation for having five infants in attendance which is over the maximum capacity. During todays inspection LPAs verified that there were only four infants in attendance and four children older than 2. Deficiency is cleared.

No deficiencies are cited based on todays visit. Exit interview was conducted with Licensee Jacqueline Calderon. Notice of Site visit was provided.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Mandie Goodwin
LICENSING EVALUATOR SIGNATURE: DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/18/2024
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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