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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393616949
Report Date: 04/17/2023
Date Signed: 04/25/2023 05:34:34 PM

Document Has Been Signed on 04/25/2023 05:34 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:ALVARADO, JAZARYFACILITY NUMBER:
393616949
ADMINISTRATOR:ALVARADO, JAZARYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 229-1446
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY: 14TOTAL ENROLLED CHILDREN: 12CENSUS: 6DATE:
04/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Jazary AlvaradoTIME COMPLETED:
02:30 PM
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On 4/17/23, Licensing Program Analyst (LPA) Corina Beckby met with the Licensee, Jazary Alvarado, for the purpose of a case management visit to clear a Type A deficiency from March 22, 2023. LPA observed Licensee and assistant caring for 6 children (ages: 17m, 2,2,2,4,& 4 years old).

Licensee is aware that when she is alone, she reverts to a small license capacity. When an assistant arrives, she can continue with a large license capacity. Assistant 1 arrives at 9:00 am and stays until everyone leaves around 5:00 pm -5:15 pm. Assistant 2 is on an on call basis.

An Exit interview was conducted, and the report was reviewed and provided to Licensee. LPA discussed and provided Appeal Rights to Licensee. LPA posted the Notice of Site Visit and Licensee acknowledges it must remain posted for 30 days. A Failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Corina Beckby
LICENSING EVALUATOR SIGNATURE: DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/17/2023
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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