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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 515408206
Report Date: 03/29/2024
Date Signed: 03/29/2024 04:21:27 PM

Document Has Been Signed on 03/29/2024 04:21 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
CHICO CC RO, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:TEJADA, JAMIE FAMILY CHILD CARE HOMEFACILITY NUMBER:
515408206
ADMINISTRATOR:TEJADA, JAMIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 635-3746
CITY:YUBA CITYSTATE: CAZIP CODE:
95993
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 0DATE:
03/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:21 PM
MET WITH:Jamie TejadaTIME COMPLETED:
04:30 PM
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On 3/29/24 at 4:21 PM an unannounced case management inspection was made by Licensing Program Analyst (LPA) Elizabeth Friese. The purpose of the inspection is to serve the licensee, Jaime Tejada, with an Immediate Exclusion Order due to conduct inimical. The order was personally served to Jamie Tejada.

The licensee informed the Department that she has surrendered the license as of today’s date. LPA Friese obtained the license, and also observed that there were no children in care during the inspection.
SUPERVISORS NAME: Erin Virrueta
LICENSING EVALUATOR NAME: Elizabeth Friese
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2024
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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