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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015700223
Report Date: 04/14/2021
Date Signed: 04/14/2021 01:29:29 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET STE 1102
OAKLAND, CA 94612
FACILITY NAME:DALE, LINDSEYFACILITY NUMBER:
015700223
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
04/14/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Lindsey DaleTIME COMPLETED:
01:45 PM
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On 4/14/2021 Licensing Program Analyst (LPA) Jaylena Miller met with Licensee Lindsey Dale for a case management visit for the purpose of inspecting a new climbing structure. LPA checked for any loose bolts or parts, sharp objects and the sturdiness of the structure. During the inspection LPA observed the climbing structure to be free of loose bolts, parts or sharp objects and deemed the climbing structure safe at this time. The structure will be inspected during every annual inspection to ensure the health and safety of children.

The climbing structure is approved as of 4/14/2021.

No deficiencies cited today. Notice of Site visit was given and must be posted for 30 days. Exit interview conducted with Licensee, Lindsey Dale.
SUPERVISOR'S NAME: Wynn NoronaTELEPHONE: (510) 421-1324
LICENSING EVALUATOR NAME: Jaylena MillerTELEPHONE: (510) 292-8297
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2021
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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