<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393616949
Report Date: 05/26/2023
Date Signed: 05/26/2023 10:22:42 AM

Document Has Been Signed on 05/26/2023 10:22 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 SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:ALVARADO, JAZARYFACILITY NUMBER:
393616949
ADMINISTRATOR:JAZARY ALVARADOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 229-1446
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY: 14TOTAL ENROLLED CHILDREN: 10CENSUS: 0DATE:
05/26/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jazary AlvaradoTIME COMPLETED:
10:30 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPA) Corina Beckby met with Licensee Jazary Alvarado for the purpose of conducting an unannounced case management visit to follow up on an Unusual Incident Report that was submitted on May 23, 2023. No children were present.

LPA interviewed with Licensee regarding Incident.

No Title 22 deficiencies were observed or were cited on today’s date. Exit interview was conducted, and report was reviewed with Director. A Notice of Site Visit was provided and should remain posted for a period of 30 days. 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: 05/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1