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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622672
Report Date: 08/03/2022
Date Signed: 08/03/2022 12:53:50 PM

Document Has Been Signed on 08/03/2022 12:53 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:DE TORRES GOMEZ, CELINAFACILITY NUMBER:
393622672
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 5DATE:
08/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Celina De Torres GomezTIME COMPLETED:
01:00 PM
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On Wednesday, August 3rd, 2022, at 12:00pm, Licensing Program Analyst (LPA) and Licensing Program Manager (LPM) Bettina Engelman conducted an unannounced Case Management visit and met with Licensee, Celina De Torres Gomez. Purpose of the visit was to meet with Licensee for an informal meeting and to discuss prior citation issued on 03/11/22 regarding unsecured weapon in the home. Present at the facility was Licensee caring for five children. Licensee's adult son was also present during the inspection.

LPM defined the difference between Non-Compliance conference and an Informal meeting. LPM advised that the purpose of today's meeting is to help provider gain compliance. During today's inspection LPA and LPM corroborated that the weapon is appropriately secure according to Title 22 regulations. Licensee stated that there is no ammunition in the home.

LPM advised Licensee to make sure she is aware of any weapons in the home and responsible for safe storage according to Title 22 regulations. Licensee acknowledge that she understood and she will make sure is in compliance.

LPA Sierra provided Spanish translation during the inspection visit.

This report and Appeal of Rights were discussed and provided. Exit interviewed conducted Notice of Site Visit posted.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Elvira Sierra
LICENSING EVALUATOR SIGNATURE: DATE: 08/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/03/2022
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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