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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313609488
Report Date: 12/13/2019
Date Signed: 12/13/2019 08:02:33 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:ROOT, NICHOLEFACILITY NUMBER:
313609488
ADMINISTRATOR:ROOT, NICHOLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 889-5508
CITY:AUBURNSTATE: CAZIP CODE:
95603
CAPACITY:14CENSUS: DATE:
12/13/2019
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Nichole RootTIME COMPLETED:
08:15 AM
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Licensing Program Analyst (LPA) Jeremey McClain conducted a Plan of Correction (POC) inspections with licensee Nichole Root regarding the violations that were cited on 12/11/2019.

Licensee was cited for having an infant sleeping in a Rock-n-Play sleeper that was recalled and not allowed in Family Child Care homes. The Rock-n-Play sleeper is no longer at the facility, and the licensee has a play pen for the infant to sleep in.

On 12/11/2019, the licensee was also cited for her assistant not having record of the required immunizations. Licensee provide proof of assistant’s immunizations during today’s inspections.

Both deficiencies are considered cleared. A letter of clearance was left with the licensee. No Title 22 violations were observed during today’s inspection.

This report was reviewed with the licensee, and a Notice of Site Visit was posted.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Jeremey McClainTELEPHONE: (916) 216-7801
LICENSING EVALUATOR SIGNATURE:

DATE: 12/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2019
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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