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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343617984
Report Date: 08/23/2022
Date Signed: 08/23/2022 02:04:08 PM


Document Has Been Signed on 08/23/2022 02:04 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, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:MAHONEY, JENNIFERFACILITY NUMBER:
343617984
ADMINISTRATOR:MAHONEY, JENNIFERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 735-7940
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:14CENSUS: 2DATE:
08/23/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Jennifer MahoneyTIME COMPLETED:
02:25 PM
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Licensing Program Analysts Lea Habtom met with licensee Jennifer Mahoney to follow up on an incident that occurred on May 2, 2022. Licensee submitted the incident on an Unusual Incident Report.

A census was taken which included 2 infants supervised by licensee.

LPA interviewed licensee Jennifer Mahoney who stated that two children were hiding between the sofa and the coffee table giggling. Licensee stepped into the kitchen for about two minutes and when she returned, she saw a child zipping up their pants. Licensee was notified by a child that the other child showed their private part. Licensee spoke to both children about playing with their clothes on and to not expose any covered body parts. Both parents were contacted and notified of the incident as well as a report filed with the Department of Child, Family and Adult services. One child was given a 60-day notice of termination and licensee agreed to have both children separated if they were left unsupervised.

Based on information available LPA concluded that there were no title 22 violations.

SUPERVISOR'S NAME: Keven PetersTELEPHONE: (916) 263-5728
LICENSING EVALUATOR NAME: Lea HabtomTELEPHONE: (916) 208-2538
LICENSING EVALUATOR SIGNATURE:
DATE: 08/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/23/2022
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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