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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 173010140
Report Date: 12/13/2021
Date Signed: 12/13/2021 02:04:20 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:HECKARD, JASMINE FCCHFACILITY NUMBER:
173010140
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 0DATE:
12/13/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jasmine HeckardTIME COMPLETED:
02:15 PM
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Licensing Program Analyst Glenn Ouye arrived to conduct a capacity increase visit. LPA Ouye met with licensee Jasmine Heckard.

The home is a three bedroom and two bathroom single level home. The living room, family room, hall bathroom are the on limits area. The spare bedroom, master bedroom, laundry room and garage are off limits, The licensee will use the front covered porch as an outdoor play area. The top of the stairs leading to the front porch has a child safety gate. There is no fireplace in the home.

There are no poisons stored in the home. The licensees does have a firearm that meets the regulatory requirements for storing a firearm.

The smoke detector and carbon monoxide detectors were tested and functional. There is a fire extinguisher rated at 2A10BC.

The facility is approved for licensure effective today, December 13, 2021.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Glenn OuyeTELEPHONE: (707) 588-5042
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2021
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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