Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573620071
Report Date: 12/01/2017
Date Signed 12/01/2017 01:26:08 PM

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:TWINKLE LITTLE STAR CENTERFACILITY NUMBER:
573620071
ADMINISTRATOR:INIGUEZ, JOSEFINAFACILITY TYPE:
830
ADDRESS:1401 EAST GUM AVETELEPHONE:
(530) 204-9709
CITY:WOODLANDSTATE: CAZIP CODE:
95776
CAPACITY:12CENSUS: 5DATE:
12/01/2017
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:JosefinaTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Jeanne Smith met with the Licensee/Director, Josefina Iniguez. During today's inspection the Director requested an extension for a plan of correction that was due on 11/20/2017. As of today the extension request was provided to LPA Smith who will submit request to LPM Ogbodo for review. Additional documents providing proof that the POC is in progress were also obtained by LPA Smith. An exit interview was conducted.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Jeanne SmithTELEPHONE: (916) 208-4405
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2017
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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