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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623729
Report Date: 11/29/2021
Date Signed: 11/29/2021 02:10:34 PM

Document Has Been Signed on 11/29/2021 02:10 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:TONG-PAQUIN, TAMMYFACILITY NUMBER:
343623729
ADMINISTRATOR:TONG-PAQUIN, TAMMYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 709-4697
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 0DATE:
11/29/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Tammy Tong-PaquinTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 1:15pm for an unannounced case management inspection. No daycare children present at time of visit. Licensee stated she is not currently watching day care children and requested to put her license on Inactive status. Licensee completed an inactive status form (LIC9211) at time of visit. LPA explained all inactive requirements to licensee at time of visit. No inspection of the home was conducted today. LPA notified licensee to contact the department prior to starting care and that an inspection is required to be placed back on Active status.

LPA consulted with licensee regarding changing on-limits portions of the facility, the process of placing the facility back on active status and changing back to a small license.

No deficiency issued at time of visit. Exit interview conducted and report was reviewed with the licensee.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE: DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/29/2021
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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