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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173001005
Report Date: 06/02/2022
Date Signed: 06/02/2022 02:20:35 PM


Document Has Been Signed on 06/02/2022 02:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:BLEVINS, JULIE FAMILY DAY CARE HOMEFACILITY NUMBER:
173001005
ADMINISTRATOR:BLEVINS, JULIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 530-9422
CITY:LAKEPORTSTATE: CAZIP CODE:
95453
CAPACITY:14CENSUS: 11DATE:
06/02/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Julie BlevinsTIME COMPLETED:
02:30 PM
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An unannounced case management visit was conducted by Licensing Program Analysts Sebastian Phouthavong and Jennifer Velasco (LPAs), who met with Licensee Julie Blevins (L1) because an anonymous caller (A1) stated there was an uncleared adult (A2) living or working in the facility who was in the facility during hours of care. A1 expressed concern A2 posed a potential risk to children in care. Interviews, facility documents, and LPA observations did not support this assertion. No deficiencies were cited during today's inspection. LPAs toured the facility, requested facility documents, and conducted interviews regarding information received by the Department. L1 stated her hours are 7:30 a.m. - 5:30 p.m., Monday through Friday, year round. Based on LPA observations, witness interviews, and record reviews, there is no uncleared adult living or working at the facility.

No deficiencies were cited during this inspection. A notice of site visit was provided to L1, who will post it in the facility for 30 days.


SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian PhouthavongTELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2022
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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