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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394501159
Report Date: 07/02/2024
Date Signed: 07/02/2024 02:32:32 PM

Document Has Been Signed on 07/02/2024 02:32 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:RODRIGUEZ GOMEZ, ALEJANDRAFACILITY NUMBER:
394501159
ADMINISTRATOR/
DIRECTOR:		FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 0DATE:
07/02/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Alejandra Rodriguez GomezTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 7/2/24, Licensing Program Analyst (LPA) Carla Polanco conducted a follow up pre-licensing visit and met with applicant, Alejandra Rodriguez Gomez.

The purpose of today's inspection was to verify the corrections requested on inspection visit dated 6/20/24; in which LPA observed the following needed corrections..
-Fireplace in the living room must be properly barricaded to prevent access by children in care.
-Backyard fence must be fixed.
-Crawl space at the back of the home must be properly covered to prevent access by child in care.
-Play room with access to the backyard must be organized and hazardous items must be properly stowed away and/or made inaccessible to children in care.

During today's inspection, LPA verified that all requirements had been met and corrections had been made.

Effective today 7/2/24, the facility is licensed to serve a Max. capacity of 8 children with no more than 3 infants, or 4 infants only, or up to 8 children with no more than 2 infants, 1 child in Transitional Kindergarten or above, and 1 child at least age 6. Infants are children under the age of 2.

Exit interview was conducted and the report was reviewed with the Applicant. LPA posted the notice of site visit. Licensee Appeal rights were provided.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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