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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624229
Report Date: 07/27/2023
Date Signed: 07/27/2023 11:58:02 AM

Document Has Been Signed on 07/27/2023 11:58 AM - 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:FLORES MENDEZ, JESSAMINFACILITY NUMBER:
343624229
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
07/27/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Jessamin FLores MendezTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Gagandeep Singh met with the licensee, Jassamin Flores Mendez, for a case management inspection. The licensee submitted an application to increase the capacity from eight to fourteen children in care.

During today’s inspection, LPA inspected the child care area. Per licensee, there are no changes in the areas accessible to the children inside the home. Per licensee, licensee rearranged the left side yard and will be using for the children and also for emergency exit. During inspection, LPA inspected the side yard and did not see any hazard. LPA reminded the licensee to inform the department prior to use any off limit areas for the children. During inspection, LPA discussed the capacity and ratio regulations with the licensee and provided a handout.

During the inspection, LPA did not observe any hazard in the house. LPA has received the fire inspection approval from the local fire department. As of today, the facility will be granted the license to maximum of 14 children in care. Copy of this report was reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISORS NAME: Natalie Dunaway
LICENSING EVALUATOR NAME: Gagandeep Singh
LICENSING EVALUATOR SIGNATURE: DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/27/2023
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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