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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343624946
Report Date: 09/05/2024
Date Signed: 09/05/2024 12:47:22 PM

Document Has Been Signed on 09/05/2024 12:47 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:LOPEZ, JOANNAFACILITY NUMBER:
343624946
ADMINISTRATOR/
DIRECTOR:		LOPEZ, JOANNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(831) 406-9035
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
09/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Joanna RochaTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Gagandeep Singh met with the licensee for a case management inspection. The licensee has changed her last name and requested to update the facility license showing the updated last name.

During today’s inspection, LPA obtained the signed application (LIC279) with new updated last name. LPA updated the last name in the licensing records on site. LPA informed the licensee that the original license will be mailed to the licensee within next five business days. During today’s inspection, LPA did not observe any violation of regulations. 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: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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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