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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500489
Report Date: 10/17/2024
Date Signed: 10/17/2024 10:04:54 AM

Document Has Been Signed on 10/17/2024 10:04 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:ACEVEDO, FLORFACILITY NUMBER:
394500489
ADMINISTRATOR/
DIRECTOR:		ACEVEDO, FLORFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 390-7858
CITY:STOCKTONSTATE: CAZIP CODE:
95219
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 2DATE:
10/17/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Acevedo, FlorTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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On October 17th, 2024, at 9:15 AM, Licensing Program Analysts (LPAs) David Nguyen and Deborah Khashe met licensee Flor Acevedo to conduct a proof-of-correction inspection to verify corrections of deficiencies cited on October 16th, 2024. The purpose of the proof-of-correction inspection was explained. LPAs were granted entry into the facility by licensee. There was two (2) children present during today’s proof-of-correction inspection. Licensee's spouse was also present at the start of the inspection.

On October 16th, 2024, the facility was cited for one (1) Type A deficiency for not keeping the backyard area free of dog fecal matter, chemicals, and trash as well as for not keeping over-the-counter medication and alcoholic beverages out of children’s reach in the kitchen. In addition, the facility was cited for one (1) Type B deficiency for not completing a fire drill and logging the fire drill on the fire drill log within six (6) months.

During today's inspection LPAs toured on-limits areas. The Type A deficiency cited on October 16th, 2024, for not keeping the backyard area free of dog fecal matter, chemicals, and trash as well as for not keeping over-the-counter medication and alcoholic beverages out of children’s reach was cleared on October 17th, 2024. During today's inspection, LPAs observed no dog fecal matter, chemicals, and trash in the backyard area. LPAs also observed no over-the-counter medications and alcoholic beverages in the kitchen within children's reach.

The Type B deficiency cited on October 16th, 2024, for not completing the fire drill and logging the fire drill on the fire drill log within six (6) months was cleared on October 17th, 2024. LPAs reviewed the fire drill log and observed the fire drill was completed and was logged on October 16th, 2024.

An exit interview was conducted with licensee, Flor Acevedo. Appeal rights and a Notice of Site Visit were provided. Licensee’s signature on this form acknowledged the receipt of the form. A notice of site visit was posted by LPA Khashe and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Chayntel Hunter
LICENSING EVALUATOR NAME: David Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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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