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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343625357
Report Date: 01/22/2024
Date Signed: 01/22/2024 09:37:47 AM

Document Has Been Signed on 01/22/2024 09:37 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:ARIZAGA, JENIFERFACILITY NUMBER:
343625357
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 4DATE:
01/22/2024
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jenifer ArizagaTIME COMPLETED:
10:00 AM
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On January 22, 2024, Licensing Program Analyst (LPA) Michelle Perez, met with licensee, Jenifer Arizaga and spouse for the purpose of a capacity increase.
Upon arrival LPA observed four (4) children in care.

LPA toured the facility and observed changes made that were required by the fire inspector. LPA observed a hard wired, pull alarm, front door locks, smoke detectors, C02 detectors, and a maintained fire extinguisher.
Off limit areas remain the same: Entire upstairs and garage. Licensee is aware that children are not allowed in off limit areas for any reasons.

Effective today, January 22, 2024, the facility is approved for a large capacity to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of two years.

This report was reviewed with licensee Jenifer Arizaga and a Notice of Site Visit was provided and will be posted for 30 days.



SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Michelle Perez
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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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