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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 345920077
Report Date: 08/13/2024
Date Signed: 08/13/2024 12:44:23 PM

Document Has Been Signed on 08/13/2024 12:44 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 NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:TATAY HOMEFACILITY NUMBER:
345920077
ADMINISTRATOR/
DIRECTOR:		MADRIO, BLESILDA CFACILITY TYPE:
734
ADDRESS:9551 SOUTH CANYON COURTTELEPHONE:
(650) 580-3896
CITY:ORANGEVALESTATE: CAZIP CODE:
95662
CAPACITY: 5CENSUS: 5DATE:
08/13/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Administrator, Blesilda MadrioTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 08/13/24 , Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced to conduct Post Licensing inspection. LPA met with Administrator, Blesilda Madrio (Bessie) and explained the purpose of the visit.

Please see Annual Inspection Report ,LIC809 for date-08/13/24 for details.



SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/13/2024
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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