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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334844834
Report Date: 03/04/2022
Date Signed: 03/04/2022 01:24:06 PM


Document Has Been Signed on 03/04/2022 01:24 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: 7DATE:
03/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:15 AM
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 case management visit. LIcensee, Donisha Adams had submitted documents regarding construction of an in ground pool and spa. The pool was under construction from January August 23, 2021 and was completed in February 28, 2022. Licensee submitted a UIR placing her backyard off-limits during pool construction beginning August 23, 2021 until completion. LPA Domingo met with Licensee, Donisha Adams who granted LPA Domingo access into the home and backyard.

LPA Domingo took photos of the pool and backyard. The pool is located on the left side of the backyard. Behind the pool is a 3 1/2 foot retaining wall that spans the back of the pool and backyard. The right side end of the back retaining wall measures 38 inches high and continues along the right side of the back yard with a 2 ft. stacked brick wall.
Where the pool ends in the middle of the back yard there is a 5 foot vinyl fence above the 3 1/2 foot retaining wall which meets up with the 5 foot mesh fence at the ground level. However from the top of the retaining wall to the top of the mesh fence is a 1 1/2 foot difference therefore making the pool accessible if children were to climb up on to the 3 1/2 foot retaining wall.
In addition the mesh fencing needs to be reconfigured as there is a downstairs bedroom window with direct access into the pool area.

THE FOLLOWING ITEMS NEED TO BE CORRECTED AND A PLAN OF CORRECTION VISIT CONDUCTED TO ENSURE TITLE 22 REGULATION REGARDING BODIES OF WATER HAVE BEEN MET:

1. LICENSEE TO RECONFIGURE MESH FENCING MAKING SURE ALL DOWNSTAIRS BEDROOMS AND DOORS DO NOT LEAD DIRECTLY INTO THE POOL AREA.

2. LICENSEE TO CONSTRUCT FENCING ALONG THE BACK OF THE POOL MAKING ALL CLIMBABLE AREAS ARE 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: 03/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2022
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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