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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313617296
Report Date: 06/13/2019
Date Signed: 06/13/2019 08:58:48 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:AKEY, JEANNIEFACILITY NUMBER:
313617296
ADMINISTRATOR:AKEY, JEANNIEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 708-3740
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:14CENSUS: 6DATE:
06/13/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Jeannie AkeyTIME COMPLETED:
09:00 AM
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LPA received an email from provider requesting to use the side area of the backyard which has been fenced off from the pool and was not being used by day care children. LPA did a health and safety evaluation and advised licensee to cover the exposed outlet for the spa and make the area inaccessible. Once that is completed, the area may be used by day care children.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2019
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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