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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500348
Report Date: 01/25/2021
Date Signed: 01/25/2021 02:36:14 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:MELIN, MELISSAFACILITY NUMBER:
344500348
ADMINISTRATOR:MELIN, MELISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 889-4780
CITY:ELK GROVESTATE: CAZIP CODE:
95757
CAPACITY:14CENSUS: 8DATE:
01/25/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:05 PM
MET WITH:Melissa MelinTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Fabiola Diaz conducted a tele-inspection due to COVID-19 pandemic with licensee Melissa Melin for an unannounced case management (licensee initiated). The purpose of today's tele-visit was to do a health and safety inspection of the kitchen and living room. Licensee requested to make the kitchen and living room off-limits. Off-limits areas will remain inaccessible to children by closed doors and/or supervision. Licensee stated that children in care will be using the front door and the side yard gate to access the back yard. Licensee stated that the children will be supervised at all times when walking to the backyard and while they are in the backyard. Licensee understands that she must contact LPA prior to making an off-limits area on-limits and vice versa. Licensee understands that if any structural changes are made to the home; licensing must be notified prior to construction.

Effective today the off-limit areas of the facility are: laundry room, all bedrooms, entire upstairs, garage, kitchen, and living room.

No citations were given during the inspection and an exit interview was conducted. A copy of this report was e-mailed to the licensee to keep on file at the facility. A “read receipt” and/or an e-mail from licensee stating licensee has read this report is in lieu of a signature due to COVID-19. Licensee may provide a signed copy of the report if able to do so.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 01/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/25/2021
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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