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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500858
Report Date: 09/28/2023
Date Signed: 09/28/2023 01:45:04 PM

Document Has Been Signed on 09/28/2023 01:45 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:TAVARA, JIMMY & MEJIA, EVELINFACILITY NUMBER:
394500858
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
09/28/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:38 PM
MET WITH:Licensee Jimmy TavaraTIME COMPLETED:
02:30 PM
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On 9/28/23, Licensing program Analyst (LPA) Carla Polanco conducted an unannounced case
management visit and met with Licensee, Jimmy Tavara. LPA was granted entry by Licensee. Today's inspection was for the purpose of converting the off-limit backyard in the FCCH back to on-limit areas.

During today's visit there were no day-care children present.

During the inspection, LPA observed that the fence in the backyard was completely repaired. The stoop that leads from the back of the home to the yard was also fenced and the fireplace opening that is accessible in the backyard covered area/stoop had a mesh cover to prevent access to children in care. As of today, the backyard is on limit and will be included as part of the FCCH. LPA will update the License and send to Licensee. There is a shed in the backyard that will remain inaccessible to children, Licensee states the shed will remain locked during hours of operation.

Exit interview conducted and report was reviewed with the licensee. 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: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2023
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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