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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 344500497
Report Date: 10/04/2021
Date Signed: 10/04/2021 06:39:52 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:HILL, SENECAFACILITY NUMBER:
344500497
ADMINISTRATOR:HILL, SENECAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 716-9578
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:14CENSUS: DATE:
10/04/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
05:15 PM
MET WITH:Seneca HillTIME COMPLETED:
06:45 PM
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At 5:15pm on 10/04/21 Licensing Program Analyst (LPA) Aruna Sridharan met with licensee Seneca Hill for licensee initiated case management inspection for an announced change of location per licensee's request. Licensee moved from previous licensed(343620228) address: 9164 Cerrolinda Circle, Elk Grove CA 95758 to current home at 6409 Kilconnell Drive, Elk Grove, CA 95758. The hours of operation are Monday-Friday 7:00 am to 5:00pm. The fire clearance was received on 09/22/2021. All adults are fingerprint cleared.
LPA toured the home inside and out. The licensee rents the home which is a single storey home with three bedrooms and two bathrooms. OFF LIMIT areas include: all three bedrooms, laundry and garage. Licensee acknowledges that children may never enter these off-limit areas.
The entire outside area was toured and no bodies of water were found. The front yard is unfenced and the backyard area is fenced. The licensee understands that 100% supervision is needed when children are in an unfenced area. Licensee understands that prior to making altercations or additions to the home or grounds the licensee shall notify Licensing Agency per regulation 102416.3
Home has working carbon monoxide and smoke detectors that meet regulations. The 2A-10-B-C fire extinguisher is wall mounted in the family room next to kitchen. The fireplace in the family room is screened. There are no firearms as stated by licensee. Hazardous cleaning compounds are stored in the locked cabinet in the garage. Sharp utensils like knives are stored in the upper cabinet in the kitchen inaccessible to children. The medications are stored in the master bedroom. The home contains appropriate toys for the children.
The Licensee has certificates of completion for 15 hours of health and safety training including Lead Poisoning Prevention module certificate completed on 09/22/2021. Licensee has CPR and First Aid (exp:09/2022) and Mandated Reporter (exp: 03/2022).
LPA advised Licensee to follow COVID guidelines and precautions to provide care for children at this time.
LPA has provided the licensee with the web site www.ccld.ca.gov to enable access to all updated forms, requirements and changes. LPA advised the licensee of their responsibility to stay current in the requirements of the Department. LPA reviewed the fire drill requirements and the last fire drill documented is 5/17/21. LPA reviewed postings. Licensee currently does not have liability insurance and will be using the affidavit for parents to sign.
LPA will recommend approval for a change of location as of today.
Notice of Site Visit was posted.
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Aruna SridharanTELEPHONE: (916) 917-9273
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021
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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