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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623072
Report Date: 10/24/2023
Date Signed: 10/24/2023 12:17:32 PM

Document Has Been Signed on 10/24/2023 12:17 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:AGUILAR, ELVIRA & JESUSFACILITY NUMBER:
343623072
ADMINISTRATOR:AGUILAR, ELVIRA/ JESUSFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 667-3065
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 4DATE:
10/24/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Elvira & Jesus AguilarTIME COMPLETED:
12:30 PM
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On 10/24/2023, Licensing Program Analyst Katy Velazquez (LPA) conducted a field visit to the facility for the purpose of a case management inspection regarding a Plan of Correction. LPA arrived at the facility and was met by Licensee Elvira Aguilar (L1) and Licensee Jesus Aguilar (L2). LPA disclosed the purpose of the inspection and was granted entrance into the Family Childcare Home (FCCH). Also present in the FCCH was L1's adult child. LPA determined through accessing Guardian that all required adults were background cleared and associated to the license.

LPA conducted a file review of children's files on 10/24/2023. LPA observed that the files were complete and contained both required forms and immunizations. As a result, LPA cleared the citation dated 09/19/2023. No deficiencies were cited in the areas that were observed on 10/24/2023.

An exit interview was conducted, and the report was reviewed with L1. LPA provided L1 with Licensee Appeal Rights. A Notice of Site visit was posted by LPA and must remain posted on, or immediately adjacent to, the interior side of the main door 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: Katy Velazquez
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2023
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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