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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
283003772
Report Date:
10/31/2022
Date Signed:
10/31/2022 02:20:28 PM
Document Has Been Signed on
10/31/2022 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:
BROWN, MARIA & CORY FCCH
FACILITY NUMBER:
283003772
ADMINISTRATOR:
BROWN, MARIA/CORY
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
(707) 254-9163
CITY:
NAPA
STATE:
CA
ZIP CODE:
94558
CAPACITY:
14
CENSUS:
10
DATE:
10/31/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
01:55 PM
MET WITH:
Maria Brown, Licensee
TIME COMPLETED:
02:35 PM
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LPA Kevin O'Connell made an unannounced case management inspection to inspect two new play structures in the back yard.
One play structure was purchased and installed from Costco. The other play structure was purchased and installed from Wayfair.
Anchors from each manufacture were used and both were secure.
There are rubber chips underneath both climbing/ play structures to absorb falls.
Both are approved for use.
Notice of Site Visit is to be posted for 30 days from today.
SUPERVISOR'S NAME:
Leslie Lepori
TELEPHONE:
(707) 588-5060
LICENSING EVALUATOR NAME:
Kevin O'Connell
TELEPHONE:
(707) 588-5026
LICENSING EVALUATOR SIGNATURE:
DATE:
10/31/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/31/2022
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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