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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618994
Report Date: 01/06/2020
Date Signed: 01/06/2020 01:28:12 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:UNDERHILL, OFELIAFACILITY NUMBER:
343618994
ADMINISTRATOR:UNDERHILL, OFELIAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 419-2191
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:14CENSUS: 9DATE:
01/06/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Ofelia Underhill, LicenseeTIME COMPLETED:
01:40 PM
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Licensing Program Analysts (LPAs) Joleen Kenney and Tanya Washington conducted an unannounced case management inspection and met with the Licensee Ofelia Underhill. The purpose of today's inspection was to clear the citation that was issued on 12/13/2019. LPA observed that the Licensee was operating within the capacity of the License. LPA Kenney printed a letter clearing the deficiency during the inspection.

No deficiencies were observed or cited during today's inspection. Exit interview conducted and a Notice of Site visit was provided and posted.
SUPERVISOR'S NAME: Roxana SaraviaTELEPHONE: (916) 263-5715
LICENSING EVALUATOR NAME: Joleen KenneyTELEPHONE: (916) 799-9668
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2020
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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