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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293602570
Report Date: 02/06/2020
Date Signed: 02/06/2020 11:12:59 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:BROWN, FREDENEFACILITY NUMBER:
293602570
ADMINISTRATOR:BROWN, FREDENEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
5303202991
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:14CENSUS: 11DATE:
02/06/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Fredene BrownTIME COMPLETED:
11:30 AM
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An unannounced plan of correction inspection was conducted today by LPA's Habtom and Owens. The purpose of the inspection is to follow up on the deficiencies assessed on January 30, 2020.

The census for today was 11 day care children ages 4, 2, 3, 2, 1, 2, 2, 2, 2, 3, 1 overseen by licensee Fredene Brown and her assistant Morgan Atkins. The licensee is in compliance with ratio and capacity at time of inspection.

LPA's also observed proof of immunization's for licensee for Tdap, MMR and has waived the flu shot in writing. Licensee's spouse was granted a waiver for immunization's from his physician.

Deficiency cleared on 2/6/2020.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2020
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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