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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393609167
Report Date: 06/20/2024
Date Signed: 06/20/2024 02:39:58 PM

Document Has Been Signed on 06/20/2024 02:39 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:AVILA, BARBARAFACILITY NUMBER:
393609167
ADMINISTRATOR/
DIRECTOR:		BARBARA AVILAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 814-8945
CITY:MANTECASTATE: CAZIP CODE:
95337
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
06/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Barbara AvilaTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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June 20,2024 LPA's Janie Davis and Lauren Scott met with licensee Barbara Avila for the purpose of an unannounced case management inspection to change backyard from off limits to on limits. LPA's toured the facility and backyard at time of inspection. LPA's observed hot tub to be latched and locked per title 22 regulations. As of today 6/20/2024 the backyard is on limits. Exit interview conducted and report was reviewed with the licensee, Barbara Avila. A Notice of Site Visit was given and must remain posted for 30 days for parental review. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.
SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: Janie Davis
LICENSING EVALUATOR SIGNATURE: DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/20/2024
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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