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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500171
Report Date: 04/15/2022
Date Signed: 04/15/2022 05:00:55 PM

Document Has Been Signed on 04/15/2022 05:00 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:GONZALEZ, MA NATIVIDADFACILITY NUMBER:
394500171
ADMINISTRATOR:GARCIA, NATIVIDADFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 642-3525
CITY:STOCKTONSTATE: CAZIP CODE:
95209
CAPACITY: 14TOTAL ENROLLED CHILDREN: 15CENSUS: 9DATE:
04/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Ma Natividad GpnzalezTIME COMPLETED:
04:30 PM
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On Friday, April 15, 2022, Licensing Program Analyst (LPA), Elvira Sierra and Licensing Program Manager (LPM) Bettina Engelman met today with Licensee, Ma Natividad Gonzalez for a Case Management Inspection. Licensee is requesting to add the backyard and the homework room located by the entrance on the first floor to the daycare areas. Upon arrival present in the facility was Licensee's Assistant, Briana Roman caring for six children (2 infants and 4 preschool children). Licensee arrived later during the inspection with 3 children (one infant and 2 school age).

LPA inspected the backyard and the homework room on today's visit. Backyard appear to be safe for children’s use. Backyard is fenced for supervision and is free of any debris or dangerous conditions. Homework room was inspected and appear suitable for children no dangerous items were observed. On today’s inspection backyard and the homework room are approved to be used by the daycare children.

A notice of site visit was given and must remain posted for 30 days. Exit interview conducted and report was reviewed with the Licensee, Ma Natividad Gonzalez.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2022
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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