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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620590
Report Date: 12/04/2024
Date Signed: 12/04/2024 11:40:41 AM

Document Has Been Signed on 12/04/2024 11:40 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:ANDRADE, IRLANDAFACILITY NUMBER:
393620590
ADMINISTRATOR/
DIRECTOR:		ANDRADE, IRLANDAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(510) 228-6122
CITY:LATHROPSTATE: CAZIP CODE:
95330
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
12/04/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:Irlanda AndradeTIME VISIT/
INSPECTION COMPLETED:
12:00 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
Licensing Program Analyst (LPA) Erwin Tjhia met with licensee Irlanda Andrade on 12/04/2024 for the purpose of an unannounced plan of correction inspection to clear a Type A deficiency, which was issued on 11/21/2024 for having an unfingerprinted adult at the facility. There were 10 children present supervised by Licensee and a staff.

During today's inspection LPA observed a document that the adult has been fingerprinted but has not been cleared. LPA discussed with the licensee that the employee should not be present at the facility until the fingerprint is clear. The deficiency cited on 11/21/2024 for unfingerprinted adult at the facility cannot be cleared today.

An exit interview was conducted and Notice of Site Visit was posted by LPA and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Appeal rights were discussed and a printed version was given to licensee.

SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Erwin Tjhia
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2024
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