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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622227
Report Date: 12/10/2019
Date Signed: 12/10/2019 01:18:30 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:SHOEMAKER, LAURAFACILITY NUMBER:
313622227
ADMINISTRATOR:SHOEMAKER, LAURAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 228-7159
CITY:LINCOLNSTATE: CAZIP CODE:
95648
CAPACITY:14CENSUS: 8DATE:
12/10/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Laura ShoemakerTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Amanda Blesi arrived unannounced for an annual inspection. LPA was met by licensee Laura Shoemaker. Also present was Bruce King, assistant Isabella Mitchell and licensee's minor child. LPA asked if anyone else was present in the home today and licensee stated no. LPA toured areas of the home accessible to children in care. Off-limit areas: upstairs, laundry room and garage. Licensee acknowledged that children may never enter these off-limit areas. The census upon arrival included 8 children with one child under age two. Licensee stated there are no new residents in the home since licensure. Adult residents have criminal record clearances. LPA observed CPR/First Aid certificates expiring 7/2021. LPA discussed upcoming infant sleep regulations and recent changes in licensing requirements, including the posting of licensing inspection notices and reports and Parent Notification Requirements. LPA reviewed some children’s files. LPA observed fire drills were conducted at least once every six months and last fire drill was conducted on 10-17-19. LPA observed that there were no hazardous items accessible to children. Fireplace is screened. LPA observed cleaning materials were inaccessible. Licensee stated there are no weapons in the home. Fire extinguisher and smoke detector meet regulation. There is a working carbon monoxide detector present. Toys appear to be safe. The backyard is fenced and gated. There are no bodies of water observed.

LPA provided the Community Care Licensing website www.ccld.ca.gov, so the licensee can obtain updated licensing information, new regulations and access forms. LPA advised licensee of their responsibility to stay current in regards to new regulations. LPA also included the email address for the children's advocacy program to stay current on new laws childcareadvocatesprogram@dss.ca.gov

Per California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiencies are cited during today's inspection. Appeal rights provided.

Licensing report was reviewed and discussed with licensee. Notice of site Visit Posted.
SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Amanda BlesiTELEPHONE: (916) 208-3427
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2019
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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