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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313605991
Report Date: 01/11/2021
Date Signed: 01/11/2021 10:40:44 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:CHAMBERS, LAURAFACILITY NUMBER:
313605991
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
01/11/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Laura ChambersTIME COMPLETED:
10:30 AM
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NOTE: Due to COVID19 pandemic and DPH guidelines on stay at home orders, a Tele-visit via FaceTime is being conducted. On Monday, January 11, 2021, approximately at 10:00 AM, Licensing Program Analyst (LPA) Amanda Blesi conducted a Case Management tele-inspection for the purpose of increasing the capacity from 8 to 14 children. During the tele-inspection there were 5 children supervised by Licensee and her adult son and daughter. The Fire Safety Clearance has been granted by South Placer Fire of Granite Bay/Loomis on 01/08/2021. With the help of Licensee, a health and safety inspection of all areas accessible to children was conducted. There are no off limit areas. Posted License, Parent's Rights, Emergency Disaster Plan, Roster of the enrolled children, and Fire Drill Log are all being maintained by the Licensee. LPA also observed recommended COVID19 posters. Hazardous items were stored inaccessible to children in care. Weapons were observed to be locked and stored separately. Fire extinguisher (2A10BC), carbon monoxide and smoke detector meet regulation. Toys appear to be safe. The backyard is fenced. The Licensee understands that in unfenced areas 100% supervision of children is required. There are 5 pool gates and fences that were observed to self close and self latch during today's tele visit. Licensee understands that prior to making alterations or additions to the home or grounds, the licensee shall notify the Department of the proposed changes. In the areas that were evaluated, no deficiencies were observed at the time of the tele-visit.
Capacity increase is approved as of today, 01/11/2021. The facility is licensed to serve a MAX. CAP (WHEN THERE IS AN ASSISTANT PRESENT): 12 - NO MORE THAN 4 INFANTS. CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6.
This report (LIC809) and a Notice of Site Visit (LIC9213) will be delivered to the Licensee 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: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2021
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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