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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 394500201
Report Date: 10/05/2023
Date Signed: 10/05/2023 11:28:41 AM

Document Has Been Signed on 10/05/2023 11:28 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:GARCIA, MAYRA VERENICEFACILITY NUMBER:
394500201
ADMINISTRATOR:GARCIA, MAYRA VERENICEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 561-6220
CITY:LATHROPSTATE: CAZIP CODE:
95330
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
10/05/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:54 AM
MET WITH:Licensee Mayra Verenice GarciaTIME COMPLETED:
11:45 AM
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On 10/5/23, Licensing program Analyst (LPA) Carla Polanco conducted an unannounced case-management visit and met with Licensee Mayra Verenice Garcia. LPA was granted entry by Licensee. Today's inspection was for the purpose of adding a second bathroom to the daycare. The bathroom was inspected by LPA and was determined to be safe for children and following licensing guidelines. There were 10 children present during the inspection being supervised by Licensee and two assistants.

During the inspection, LPA observed the added bathroom to be in safe conditions. The bathroom off of the dining area will now be off-limits. Licensee understands that off-limits bathroom must remain inaccessible to children in care. As of today, 10/5/23 the bathroom inside the living room/playroom 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: Jeanne Smith
LICENSING EVALUATOR NAME: Carla Polanco Rivera
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2023
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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