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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313620693
Report Date: 11/21/2022
Date Signed: 11/21/2022 01:30:37 PM

Document Has Been Signed on 11/21/2022 01:30 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:COSTA, CRISTINAFACILITY NUMBER:
313620693
ADMINISTRATOR:COSTA, CRISTINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 488-6233
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
11/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Cristina Costa TIME COMPLETED:
01:45 PM
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 November 21, 2022 Licensing Program Analysts (LPA) Lea Habtom and Matthew Gallo conducted a case management visit due to the citation given on November 15, 2022. The purpose for today's inspection was to confirm that the licensee, Cristina Costa, is adhering to the ratio guidelines for a large license or a small license if a an assistant is present. The licensee and licensee's assistant were present in the home during today's inspection. All adults present in the home have been fingerprinted and associated to the facility. The census for today is 3 infants and 7 preschool children being supervised by licensee and her assistant. There are no Title 22 regulations cited during today's inspection and a notice of site visit was provided to be posted for 30 days. Appeal rights were provided.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
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