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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500858
Report Date: 01/09/2025
Date Signed: 01/09/2025 01:55:18 PM

Document Has Been Signed on 01/09/2025 01:55 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/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
01/09/2025
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:49 PM
MET WITH:Licensee Jimmy Tavara & Evelin MejiaTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 1/9/25, Licensing Program Analyst (LPA) Carla Polanco Rivera conducted a Case Management visit for the purpose of increasing the licensed capacity from 8 to 14 children. LPA met with Licensee's Jimmy Tavara and Evelin Mejia. Fire safety Inspection Clearance was granted on 12/31/24 for a total capacity of (14) children. Facility hours of operation are Monday through Sunday, 24 hours per day. All individuals subject to criminal background review have obtained a criminal record clearance. At the time of the inspection there were six children being supervised by Licensee's.

A health and safety inspection was conducted in all areas accessible to children. Home appears orderly and suitable for children. Off limit areas consist of the bedrooms, garage, bathroom near the laundry room and the laundry room. LPA observed that hazardous items were inaccessible to children in care. LPA observed age-appropriate toys and napping equipment. Licensee Jimmy stated there are no weapons in the home. No bodies of water were observed by LPA.



Home has a working telephone, 2A10BC fire extinguisher and functioning smoke and carbon monoxide detectors. Licensee understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes. Licensee rents the home. Licensee provided rental agreement. Licensee’s CPR/First Aid certification was verified and expires 01/2025. Mandated Reporter Training certification expires 04/2025. During the inspection LPA reviewed large family childcare home capacity limitations with licensee and a capacity roster form was provided to Licensee.

Report continued on LIC809C....
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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, EVELIN
FACILITY NUMBER: 394500858
VISIT DATE: 01/09/2025
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Licensee was reminded that all adults 18 and over living in the home, persons who provide care and supervision to children, and staff who have contact with children, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Incidental Medical Services (IMS) policy was discussed. Licensee states that he is not caring for children needing medications at this time.

LPAs discussed the safe sleep regulations, and discussed the Child Care Licensing Safe Sleep web page at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPAs also informed of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment

Effective today, 1/9/25, Licensee's are approved for a Large Family Child Care Home, with a maximum capacity of 14 children, one (1) of which must be enrolled in Kindergarten and at least one (1) 6 years of age and no more than three (3) may be infants; or 12 children, four (4) of which may be infants. Infants are children under the age of 2.

Licensee understands that when there is no assistant present, facility shall revert to that of a small family child care home.

An exit interview was conducted, and the report was reviewed with the licensee. A notice of site visit was provided and posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2025
LIC809 (FAS) - (06/04)
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