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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 103909533
Report Date: 01/11/2021
Date Signed: 01/11/2021 11:52:19 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:WALKER, KAYCEE FAMILY CHILD CAREFACILITY NUMBER:
103909533
ADMINISTRATOR:WALKER, KAYCEEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(559) 313-5287
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:14CENSUS: 11DATE:
01/11/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Kaycee WalkerTIME COMPLETED:
12:00 PM
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On this date, Licensing Program Analyst (LPA) Luisa Gavoutian conducted an unannounced Case Management – Other tele-inspection. An in-person inspection was not conducted due to COVID-19 restrictions. LPA connected to Licensee Kaycee Walker via FaceTime. Present during today’s inspection were 11 children. The purpose of today’s inspection was to discuss the Confirmation of Removal for Lindsey Holt.

During today’s inspection, Licensee stated that Lindsey has worked in the facility as an assistant. Licensee stated she will not allow Lindsey to work or be present in the home effective immediately. Licensee is aware that Lindsey may not live in the home or be present in the home while daycare children are present. LPA emailed Licensee a copy of LIC 300A – Confirmation of Removal For: Holt, Lindsey J., which Licensee is to sign and return today, LIC 995B – Family Child Care Home Addendum to Notification of Parents Rights, which must be signed by each current daycare child’s parent and a copy retained in the child’s file, and a copy of the CBCB letter discussing applying for an exemption for Lindsey. Licensee is encouraged to apply for an exemption for Lindsey.

Based on the evidence obtained during today’s inspection, LPA verified the individual is not present or residing at the facility and will stop working at the facility effective immediately. LPA has advised Licensee to disassociate the individual from her roster, if an exemption will not be requested.

Exit interview conducted with Licensee Kaycee Walker. A copy of this report shall be placed in the facility file for public review.

Verification of removal is complete.

SUPERVISOR'S NAME: Alice JuarezTELEPHONE: (559) 650-7857
LICENSING EVALUATOR NAME: Luisa GavoutianTELEPHONE: (559) 341-4725
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2021
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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