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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 093609172
Report Date: 10/28/2019
Date Signed: 10/28/2019 09:47:56 AM

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:SHERIDAN, MARIAN CAROLFACILITY NUMBER:
093609172
ADMINISTRATOR:SHERIDAN,MARIAN CAROLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 939-0334
CITY:EL DORADO HILLSSTATE: CAZIP CODE:
95762
CAPACITY:14CENSUS: 11DATE:
10/28/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Marian Carol SheridanTIME COMPLETED:
10:05 AM
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Licensing Program Analyst (LPA), Jan Hoshida, met with Licensee, Marian Carol Sheridan, for a case management inspection to verify corrections of a violation cited at the last visit. On 10/23/19, a Type A deficiency was cited for Ratio/Capacity when licensee had ten children in care without a qualified assistant.

LPA toured the facility inside and outside, observed the care and supervision of children and reviewed children’s records. LPA observed 11 children with two under the age of two years old with Licensee and a qualified assistant. LPA observed that children’s files contained signed Acknowledgements of Receipt of Licensing Report Forms (LIC 9224). The deficiency cited on 10/23/19 visit is cleared with today’s inspection.

Licensee stated that she has also found a substitute to utilize if her assistants are unavailable to work for any reason. LPA provided necessary required licensing documents for staff or adult assistants.

No Title 22 deficiencies cited during today’s inspection.

An Exit Interview was conducted, and a Notice of Site Visit was posted.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2019
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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