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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844834
Report Date: 03/08/2022
Date Signed: 03/08/2022 12:51:51 PM


Document Has Been Signed on 03/08/2022 12:51 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN STREET, STE 700
RIVERSIDE, CA 92501



FACILITY NAME:ADAMS FAMILY CHILD CAREFACILITY NUMBER:
334844834
ADMINISTRATOR:ADAMS,DONISHAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(310) 766-3193
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92532
CAPACITY:14CENSUS: DATE:
03/08/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Donisha AdamsTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA), Joanne Domingo arrived at the facility to conduct a follow up case management plan of correction visit. The initial visit was done on 3/04/22.
At that time the mesh fencing surrounding the pool did not meet Title 22 Regulations and sections of the mesh fencing allowed access into the pool area. LPA Domingo met with Licensee, Donisha Adams who granted LPA Domingo access into the home and backyard.
THE FOLLOWING ITEMS WERE CORRECTED AND MEET TITLE 22 REGULATION REGARDING BODIES OF WATER:

1. THE MESH FENCING SURROUNDS THE POOL AREA AND IS NOT CONNECTED TO THE OUTSIDE OF THE HOME. ALL DOWNSTAIRS BEDROOMS AND DOORS DO NOT LEAD DIRECTLY INTO THE POOL AREA.

2. THERE IS A 3 FOOT WIDE BY 5 FOOT TALL MESH FENCE PANEL ATTACHED TO THE BRICK RETAINING WALL AND VINYL FENCE ALONG THE BACK OF THE POOL MAKING ALL CLIMBABLE AREAS INACCESSIBLE TO THE POOL.

An exit interview was conducted, Notice of Site Visit posted and a copy of this report was provided to the Licensee, Donisha Adams on this date.

A copy of this report must be made available to the public for 3 years.
SUPERVISOR'S NAME: Stephanie HudakTELEPHONE: (951) 320-2021
LICENSING EVALUATOR NAME: Joanne DomingoTELEPHONE: (951) 233-9356
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022
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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