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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
304313899
Report Date:
07/14/2021
Date Signed:
07/14/2021 10:59:51 AM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
750 THE CITY DRIVE, SUITE 250
ORANGE
,
CA
92868
FACILITY NAME:
KAKI, SUNDA BENITO
FACILITY NUMBER:
304313899
ADMINISTRATOR:
FACILITY TYPE:
810
ADDRESS:
TELEPHONE:
CITY:
STATE:
ZIP CODE:
CAPACITY:
8
CENSUS:
0
DATE:
07/14/2021
TYPE OF VISIT:
Prelicensing
ANNOUNCED
TIME BEGAN:
10:40 AM
MET WITH:
Benito, Kaki
TIME COMPLETED:
11:15 AM
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A follow-up pre-licensing inspection conducted on this day by LPA Torrence. The following corrections observed:
1. The swimming pool had a covered which meet the department’s requirements:
Cover labeled F 1346-91 by the American Society for Testing Material
Cover support the weight of an adult
Cover is locked and secured in place so a child cannot slip under or undo
Covers shall be strong enough to completely support the weight of an adult and shall be placed on the pool and
locked while the pool is not in use.
2. Applicant bolted the sliding door leading to the pool.
LPA Torrence stood on the pool cover to ensure it holds the weight of an adult. LPA Torrence took pictures of the bolted sliding door leading to the pool and pictures of the covered pool
Facility meets all licensing requirements and file will be submitted for approval.
Exit interview conducted with applicant and a copy of this report was provided to applicant.
SUPERVISOR'S NAME:
Thuy Ho
TELEPHONE:
(714) 287-8515
LICENSING EVALUATOR NAME:
Stacy Torrence
TELEPHONE:
(714) 300-3599
LICENSING EVALUATOR SIGNATURE:
DATE:
07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/14/2021
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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