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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618946
Report Date: 09/09/2024
Date Signed: 09/09/2024 03:31:06 PM

Document Has Been Signed on 09/09/2024 03:31 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:CISNEROS, ELISAFACILITY NUMBER:
343618946
ADMINISTRATOR/
DIRECTOR:		CISNEROS, ELISAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 604-2723
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
09/09/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:30 PM
MET WITH:Elisa CinserosTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
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On Monday, 9 September 24 at approximately 4:30pm, Licensing Program Analyst (LPA) Fabian Schwartz met with Licensee Elisa Cisneros for the purpose of an unannounced annual inspection. Upon arrival, Licensee informed LPA they are no longer operating, and have not been providing childcare recently. Licensee wishes to be placed upon inactive status. LPA provided Licensee with LIC9211 which Licensee signed during time of inspection. No notice of site visit was provided due to inspection not occurring and LPA placing Licensee on inactive status.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Fabian Schwartz
LICENSING EVALUATOR SIGNATURE: DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2024
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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