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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293605175
Report Date: 10/22/2021
Date Signed: 10/22/2021 10:24:31 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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: 7DATE:
10/22/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Karen Rohde - LicenseeTIME COMPLETED:
10:40 AM
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On Friday, October 22nd, 2021, at 9:54am, Licensing Program Analyst (LPA) Blake Morillas conducted a Case Management visit for the purpose of inspecting a recently constructed in-ground pool as well as the inspection of the firearms at the home. At 9:54am LPA informed the Licensee, Karen Rohde, of the reason for the inspection. At 9:54am, 2 infants and 5 preschool age children were observed along with the Licensee and helpers. Licensee stated there are no new residents in the home. Adult residents have criminal record clearances.

Previously, an above ground pool was constructed at the home. This was removed and an in-ground pool was put in its place. The area is fenced according to Title 22 regulations with two, self latching, self closing gates. There is also a spa in the fenced area that is also covered and locked on all four sides according to regulations.

Firearms were also inspected and found to be stored in their own safe and ammunition is separately stored according to Title 22 Regulations.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

At 10:25am, LPA reviewed and discussed this facility evaluation report with the Licensee.

Notice of site visit posted.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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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