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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 283002625
Report Date: 08/21/2019
Date Signed: 08/21/2019 10:53:31 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME:MOROFSKY, LAURA FAMILY CHILD CARE HOMEFACILITY NUMBER:
283002625
ADMINISTRATOR:MOROFSKY, LAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 643-7882
CITY:AMERICAN CANYONSTATE: CAZIP CODE:
94503
CAPACITY:14CENSUS: 7DATE:
08/21/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Laura MorofskyTIME COMPLETED:
11:08 AM
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LPA Kevin O'Connell made an unannounced case management inspection in response to an application to add a large additional room in the rear of the home for child care use. The room contains a functioning combination smoke/ carbon monoxide detector and a charged 3:A 10-BC fire extinguisher.
The back yard will be off limits until the new lawn is installed.
The 4/10/13 outdoor deck waiver, requiring visual supervision when the back yard is used, is still needed. Electrical outlets are covered.
Fire Marshall approval was given 8/9/19.
This room is now approved for use.

Notice of Site Visit to be posted for 30 days from today.
No deficiencies cited.
SUPERVISOR'S NAME: Leslie LeporiTELEPHONE: (707) 588-5060
LICENSING EVALUATOR NAME: Kevin O'ConnellTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2019
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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