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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623971
Report Date: 01/12/2023
Date Signed: 01/12/2023 01:17:58 PM

Document Has Been Signed on 01/12/2023 01:17 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:PEREZ, CELIAFACILITY NUMBER:
343623971
ADMINISTRATOR:PEREZ, CELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(408) 413-8702
CITY:SACRAMENTOSTATE: CAZIP CODE:
95820
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 3DATE:
01/12/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Celia PerezTIME COMPLETED:
01:30 PM
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On January 12th, 2023, Licensing Program Analyst (LPA) Jeremey McClain met with Licensee Celia Perez for an unannounced Licensee Initiated Case Management Inspection. Licensee’s assistant was present. LPA observed three children in care which included two infants and one preschool aged child.

The licensee has requested to make the first bedroom on limits. The room consist of three play pens, three dresser drawers, a closet, and a swing. Licensee understands that the swing cannot be used for infant sleeping. LPA did not observe any hazards in the room. Licensee's request for usage of the room is approved.

The off-limit areas will now be the master bedroom and bathroom, licensee’s daughters bedroom, and the garage.
Licensee inquired about having the garage approved for usage. LPA inspected the garage and informed the licensee that all hazardous items must be inaccessible, and she may need approval from the local fire department before an LPA makes another inspection.

LPA did not observe any violations of Title 22 Regulations during today’s inspection.

This report was reviewed with the license. LPA provided a Notice of Site Visit, which must remain posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2023
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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