<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500946
Report Date: 10/22/2024
Date Signed: 10/22/2024 10:06:30 AM

Document Has Been Signed on 10/22/2024 10:06 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:RIVERA, LESLIE IRENEFACILITY NUMBER:
394500946
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 9CENSUS: 5DATE:
10/22/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:15 AM
MET WITH:Rivera, Leslie IreneTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On October 22nd, 2024, at 9:15 AM, Licensing Program Analyst (LPA) David Nguyen met licensee Leslie Irene Rivera to conduct a proof-correction inspection to verify corrections of a Type-A deficiency cited on October 17th, 2024. The purpose of the proof-of-correction inspection was explained. LPA was granted entry into the facility by licensee. There were five (5) children present during today’s proof-of-correction inspection. Licensee’s spouse was also present at the start of the inspection.

On October 17th, 2024, the facility was cited for one (1) Type A deficiency for not keeping the backyard area free of dog’s fecal matter and the side yard area free of discarded household items, the kitchen sinks free of dirty dishes and free of flies, and the entry way free of soiled diapers.

During today's inspection LPA toured on-limits areas. The Type-A deficiency cited on October 17th, 2024, for not keeping the backyard area free of dog’s fecal matter, and the side yard area free of discarded household items, the kitchen sinks free of dirty dishes and free of flies, and the entry way free of soiled diapers was cleared on October 22nd, 2024. LPA observed no dog’s fecal matter in the backyard area. In addition, the discarded household items in the side yard area have been removed. The kitchen sinks were free of dirty dishes, and kitchen and dining area free of flies. The entry way was free of soiled diapers.

An exit interview was conducted with licensee, Leslie Irene Rivera. 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 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: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1