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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293605175
Report Date: 07/31/2020
Date Signed: 07/31/2020 11:01:35 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:ROHDE, KARENFACILITY NUMBER:
293605175
ADMINISTRATOR:ROHDE, KARENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 274-1734
CITY:GRASS VALLEYSTATE: CAZIP CODE:
95945
CAPACITY:14CENSUS: 9DATE:
07/31/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Karen Rohde - LicenseeTIME COMPLETED:
10:45 AM
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NOTE: Due to Covid-19 and DPH guidelines on physical distancing, a Tele-visit via Google Duo was conducted.

On Friday, July 31st, 2020 at 10:00am, LPA B Morillas conducted a Licensee Initiated, Case Management Tele-visit with the Licensee, Karen Rohde, for the purpose of changing an off-limits room to an on-limits area. At the beginning of the Tele-Visit the Licensee was asked how many children were present. The Licensee stated that 9 children were present.

The Licensee noted that the requested room will not be used right away, but may be in the future for school age children.

At 10:06am, with the help of the Licensee, a Tele-inspection of the room was conducted. The room is located above the attached garage to the home and is accessible via a stairway from inside the home. The stairs were observed to be gated in accordance with Title 22 Regulations. In the room a gas fireplace that is appropriately barricaded was also observed.

As of today (7-31-2020), the room above the garage is an on limits area.

This report (LIC 809), Appeal Rights (LIC 9058) and a Notice of Site Visit (LIC 9213) will be delivered to the Licensees' electronically via email.

Acknowledgement of delivery will constitute acknowledgement of the report in lieu of a signature.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2020
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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