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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619138
Report Date: 06/06/2022
Date Signed: 06/20/2022 12:42:28 PM


Document Has Been Signed on 06/20/2022 12:42 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:BARRETT, CHAROLFACILITY NUMBER:
343619138
ADMINISTRATOR:BARRETT, CHAROLFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 882-4505
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:14CENSUS: 5DATE:
06/06/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Charol BarrettTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Gagandeep Singh met with the licensee, Charol Barrett, for the inspection of plan of correction. Purpose of the inspection was explained.

During today’s inspection, LPA observed that the licensee has signed up for renewal of the CPR training and the training will be held on June 18, 2022. Per licensee, licensee will be completing the Mandated reporter training during this week and will submit the completion certificate to the Department.

No deficiencies are cited today. Copy of this report is reviewed and provided to the licensee. Notice of site visit is posted and shall remain posted for next 30 days.

SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Gagandeep SinghTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:
DATE: 06/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/06/2022
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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