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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617989
Report Date: 03/14/2024
Date Signed: 03/14/2024 11:46:22 AM

Document Has Been Signed on 03/14/2024 11:46 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:NAVARRETTE, LORRAINEFACILITY NUMBER:
343617989
ADMINISTRATOR:NAVARRETTE, LORRAINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 613-3044
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
03/14/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lorraine NavarretteTIME COMPLETED:
12:00 PM
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On March 14, 2024, Licensing Program Analyst (LPA), Michelle Perez, met with licensee Lorraine Navarrette, for the purpose of a case management visit.

Licensee requested to utilize the master bedroom and add it to the on-limit portions of the house for a quiet space. Licensee will provide supervision when children are in the room.

LPA did not observe any hazards within the room and will clear the room for child care use.

Effective March 14, 2024, the master bedroom will now be on limits for child care use.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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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