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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620661
Report Date: 08/18/2021
Date Signed: 08/18/2021 10:45:05 AM

Document Has Been Signed on 08/18/2021 10:45 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:ALVARADO, MARIAFACILITY NUMBER:
393620661
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
08/18/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Maria AlvardoTIME COMPLETED:
10:50 AM
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On 8/18/21 Licensing Program Analyst (LPA) Fabiola Diaz and Licensing Program Manager (LPM) Jeanne Smith conducted a case-management at the facility to inspect an above ground pool and to continue a change of capacity inspection. On today’s date there were 4 children present supervised by licensee and licensee's adult daughter.

LPA and LPM observed the pool located in the facility’s backyard to be completely removed and that the facility did not have bodies of water on premises. LPA and LPM discussed Title 22 regulations of bodies of water and fencing with licensee. Licensee requested the facility's main backyard to become on-limits with the right and left sides of the backyard to remain off-limits. Licensee stated the shed is always off-limits and is remained locked.

On today’s date, 8/18/21 the facility was approved for a Large Family Child Care License to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above and 1 child at least age 6 with a maximum of 3 infants. Without assistant, the ratios revert to those for small family childcare home.

An exit interview was conducted. No deficiencies were cited on today’s date. A Notice of Site Visit was provided and should remain posted for 30 days.

SUPERVISORS NAME: Jeanne Smith
LICENSING EVALUATOR NAME: Fabiola Diaz
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2021
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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