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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393617525
Report Date: 09/05/2024
Date Signed: 09/05/2024 11:32:13 AM

Document Has Been Signed on 09/05/2024 11:32 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 S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MATUTE, ILMAFACILITY NUMBER:
393617525
ADMINISTRATOR/
DIRECTOR:		MATUTE, ILMAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 858-2891
CITY:LATHROPSTATE: CAZIP CODE:
95330
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 2DATE:
09/05/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:56 AM
MET WITH:Licensee Ilma MatuteTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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
On 9/5/24, Licensing program Analyst (LPA) Carla Polanco conducted an unannounced case management visit and met with Licensee Ilma Matute. LPA was granted entry by Licensee. There were two daycare children present being supervised by the Licensee during the inspection. Today's inspection was for the purpose of converting the off-limit backyard in the FCCH back to an on-limit area. Licensee speaks Spanish, the visit was conducted in Spanish and report has been translated by LPA.

During the inspection, LPA observed the backyard to be in safe conditions. LPA also observed an underground pool with pool fencing that meets tittle 22 regulations, LPA verified safety of pool gate by observing that the pool gate self close and self latched. As of today, 9/5/24 the backyard is on limit and will be included as part of the FCCH. LPA will update the License and send to Licensee.

Exit interview conducted and report was reviewed with the licensee. 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: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
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