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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393620451
Report Date: 02/26/2020
Date Signed: 02/26/2020 02:34:49 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:COLLIER, SANDYFACILITY NUMBER:
393620451
ADMINISTRATOR:COLLIER, SANDYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(650) 333-7263
CITY:MANTECASTATE: CAZIP CODE:
95336
CAPACITY:14CENSUS: 10DATE:
02/26/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Sandy CollierTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Christopher Jackson conducted a case management inspection to the facility regarding a newly finished in ground pool. Todays census was ten children in care. Also present during today's inspection was licensees assistant. All adults present in the home today have been cleared through Community Care Licensing and are associated to the facility.

Licensee stated the pool was completed in January of 2020. LPA tested the fence and observed the pool fence to open away from the body of water and the fence gate to self close and self latch. LPA observed there are no windows that provided direct access into the pool area. During today's inspection the pool fencing is in compliance with title 22 regulations.

No title 22 deficiencies were cited during today's inspection. This report was reviewed with the licensee, exit interview conducted and Notice of site visit posted.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Christopher JacksonTELEPHONE: (916) 216-8837
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2020
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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