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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393601458
Report Date: 08/28/2024
Date Signed: 08/28/2024 12:46:51 PM

Document Has Been Signed on 08/28/2024 12:46 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:ADELITA MIGRANT CHILD DEVELOPMENT CENTERFACILITY NUMBER:
393601458
ADMINISTRATOR/
DIRECTOR:		ELIZABETH RICOFACILITY TYPE:
850
ADDRESS:14320 EAST HARNEY LANETELEPHONE:
(209) 368-2087
CITY:LODISTATE: CAZIP CODE:
95240
CAPACITY: 50TOTAL ENROLLED CHILDREN: 50CENSUS: 28DATE:
08/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Elizabeth RicoTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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Licensing Program Analysts (LPA) Erwin Tjhia met with the Center Director, Elizabet Rico to follow up on an Unusual Incident Report (UIR) submitted to Community Care Licensing on 08/23/2024. During today's visit the facility was toured. LPA observed 28 children supervised by 5 staff.

LPA conducted interviews and obtained documents pertinent to the investigation.

A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today's inspection.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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