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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622657
Report Date: 07/15/2024
Date Signed: 07/15/2024 02:02:53 PM

Document Has Been Signed on 07/15/2024 02:02 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:GOMEZ, SANDRAFACILITY NUMBER:
343622657
ADMINISTRATOR/
DIRECTOR:		GOMEZ, SANDRAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 670-8519
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 14TOTAL ENROLLED CHILDREN: 11CENSUS: 8DATE:
07/15/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Sandra GomezTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Corina Beckby met with Licensee, Sandra Gomez on 7/15/2024 for the purpose of an unannounced plan of correction inspection to clear all deficiencies, issued on 06/17/2024.

LPA observed Licensee caring for 8 children including 1 infant during today's inspection. LPA toured the facility and found no deficiencies.



LPA observed 11 children's files. All files are complete and up to date.

LPA observed updated roster, fire drill log and CPR certificate which expired on 06/20/2026.

LPA observed 1 Individual Sleeping Plan for 1 infant enrolled.

LPA observed updated sleeping log for infants under 2 years old.

All deficiencies cited on 06/17/2024 are cleared effective today. Proof of correction letters were provided for the corrected deficiencies. LPA reviewed report with Licensee, Sandra Gomez. 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: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2024
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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