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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 293623239
Report Date: 06/23/2020
Date Signed: 06/23/2020 02:08:09 PM

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:STITH, LAURENFACILITY NUMBER:
293623239
ADMINISTRATOR:STITH, LAURENFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 205-7447
CITY:PENN VALLEYSTATE: CAZIP CODE:
95946
CAPACITY:14CENSUS: 13DATE:
06/23/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Lauren Stith - LicenseeTIME COMPLETED:
02:10 PM
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*NOTE: Due to Covid-19 and DPH guidelines on social distancing, a Tele-inspection was conducted via FaceTime.*

On Tuesday, June 23rd, 2020, at 1:25pm, Licensing Program Analyst (LPA) Blake Morillas conducted a Case Management Tele-inspection for the purpose of inspecting a recently installed fence around a repaired water feature in the Licensee's back yard. When the Licensee was asked how many children were present, she replied 13, consisting of 2 infants, 1 school age, and 10 preschool age children.

Before the Tele-inspection, the Licensee submitted a signed Applicant/Licensee Bodies of Water Checklist, indicating that the fencing meets Title 22 regulations for bodies of water.

The Licensee proceeded to show the LPA the entirety of the mesh style pool fencing. The Licensee then demonstrated that the gate is self-latching and self-closing. From what was observed via the Tele-Inspection, it appeared all aspects of the fencing met Title 22 regulations.

Please note: When a physical inspections takes place, requests for alterations may be made.

The report was reviewed with the Licensee and an exit interview was conducted.

Notice of site visit to be posted for 30 days.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Blake MorillasTELEPHONE: (916) 208-3734
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2020
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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