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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 033617644
Report Date: 10/19/2021
Date Signed: 10/19/2021 06:08:26 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:HESPELER, SUSANFACILITY NUMBER:
033617644
ADMINISTRATOR:HESPELER, SUSANFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 245-6393
CITY:PLYMOUTHSTATE: CAZIP CODE:
95669
CAPACITY:14CENSUS: 5DATE:
10/19/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
04:07 PM
MET WITH:Susan HespelerTIME COMPLETED:
04:27 PM
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On 8/18/21 Licensing Program Analyst (LPA) Aruna Sridharan conducted a case-management at the facility to inspect in ground pool. On today’s date there were 5 children present supervised by licensee and licensee's assistant.

LPA observed the pool located in the facility’s backyard which is gated with locks on both sides. LPA discussed Title 22 regulations of bodies of water and fencing with licensee. Licensee stated that the pool is locked all the times. Licensee stated the garage next to the pool is offlimits and always remained locked.

The pool is fully fenced and meet regulations. The licensee had submitted photos of the pool. LPA suggested to have the window barricaded with window grill so that children cannot have access to the pool.



The licensee will request for a waiver.

An exit interview was conducted. A Notice of Site Visit was provided and should remain posted for 30 days.
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021
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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