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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622339
Report Date: 05/31/2019
Date Signed: 05/31/2019 10:36:10 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:KENTON, LORIFACILITY NUMBER:
313622339
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 6DATE:
05/31/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lori Kenton TIME COMPLETED:
11:00 AM
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Licensing program Analyst (LPA) Mary Ponce met with the licensee Lori Kenton for the purpose of a capacity increase from 8 to 14 children. LPA Ponce toured all areas of the home that are accessible to children, today’s census included 6 children. Also present during today’s inspection was Licensee's son who will work in the home, and licensee's daughter. All adults working or living in the home have been finger print cleared through Community Care Licensing.

Off-limit areas include: the Master bedroom, son's bedroom, daughter's bedroom, garage, basement, and as of today 5/31/19 the backyard. Licensee acknowledged that children may never enter off-limit areas. Licensee has a fully fenced front yard with age appropriate play structures for use.

LPA observed a current roster of the enrolled children and fire drill log. LPA ponce has obtained STD850 Fire Clearance from the Roseville Fire Department. The licensee has been cleared to provide care for 14 children.

Effective today 5/31/19, LPA Ponce is granting a license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years old.

Licensee acknowledges that when there is no assistant present, facility will revert back to the small capacity. Licensee acknowledges that children residing in the home under the age of 10 years shall be included in capacity.

No Title 22 deficiencies were cited during today's inspection. Appeal Rights and Notice of Site Visit were provided. Notice of Site Visit must remain posted for 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: (916) 216-7813
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2019
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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