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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173001005
Report Date: 08/09/2022
Date Signed: 08/09/2022 02:00:24 PM


Document Has Been Signed on 08/09/2022 02:00 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: 9DATE:
08/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 AM
MET WITH:Julie BlevinsTIME COMPLETED:
02:15 PM
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An unannounced case management visit was conducted by Licensing Program Analyst, Sebastian Phouthavong, who met with Licensee Julie Blevins (L1) regarding an Unusual Incident Report submitted on 06/28/22 involving a bee’s nest location in the premise. Licensee stated that the nest is gone and has been checking everyday for more bee’s nests. Licensee stated the home has not had an issue with bees since the UIR was submitted. LPA observed no nest during the visit. Licensee also provided an update on the adult providing yard work to the home. Licensee sated that she receives yard work from three other individuals and rarely receives yard work from the previous worker. Licensee has not received phone calls from an Adult connected to the previous yard worker since changing yard workers. Licensee stated the worker come to the home on the weekends.

A notice of site visit was given and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee, Julie Blevins

There were no Title 22 deficiencies cited during today's inspection.

SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Sebastian PhouthavongTELEPHONE: 707-588-5056
LICENSING EVALUATOR SIGNATURE:
DATE: 08/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/09/2022
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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