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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622079
Report Date: 07/22/2019
Date Signed: 07/22/2019 11:57:31 AM

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:PERDUE, KRISTIFACILITY NUMBER:
393622079
ADMINISTRATOR:PERDUE, KRISTIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 740-0165
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:14CENSUS: 10DATE:
07/22/2019
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Kristi PerdueTIME COMPLETED:
12:25 PM
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Licensing Program Analysts (LPAs) Mary Ponce and Cheyntel Hunter met with licensee for the purpose of making the back yard on limits. During the inspection, LPAs toured the backyard to ensure there were no hazardous items accessible to children in care. The licensee has a pool which is appropriately fenced per Title 22 Regulations. LPA opened the pool fence gate and released to ensure the gate self latched. The gate self latched and swung outward.

As of today 7/22/19 the backyard is considered onlimits. LPA advised licensee to ensure that the backyard remains in compliance and that there are no dangerous items in the backyard during daycare hours.

Notice of Site Visit provided and must remain posted for 30 days.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Mary PonceTELEPHONE: (916) 216-7823
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2019
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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