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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618892
Report Date: 12/01/2021
Date Signed: 12/01/2021 12:11:43 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:CASEY, DAVENAFACILITY NUMBER:
343618892
ADMINISTRATOR:CASEY, DAVENAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 796-3593
CITY:SACRAMENTOSTATE: CAZIP CODE:
95834
CAPACITY:14CENSUS: 10DATE:
12/01/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Davena CaseyTIME COMPLETED:
12:20 PM
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On 12/1/21, Licensing Program Analyst (LPA) Jan Hoshida met with Licensee Davena Casey for an unannounced case management inspection. On 11/29/21, Licensee informed LPA that she has purchased a new hot tub to put in her back yard. Upon arrival, LPA observed ten children with Licensee and Licensee's Assistant.

Today, LPA inspected the hot tub and observed it is covered, equipped with locking latches on all four sides, and is inaccessible to children in care which meets Title 22 Regulations.

No deficiencies were cited in today’s inspection.

Exit interview was conducted and Notice of Site Visit was posted.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Jan HoshidaTELEPHONE: (916) 917-6572
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
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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