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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622079
Report Date: 02/12/2020
Date Signed: 02/12/2020 02:54:28 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:PERDUE, KRISTIFACILITY NUMBER:
393622079
ADMINISTRATOR:PERDUE, KRISTIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 740-0165
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:14CENSUS: 9DATE:
02/12/2020
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Kristi Perdue TIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Stacey Williams conducted a plan of correction inspection for the purpose of clearing deficiencies cited during an annual inspection. LPA met with Licensee, Krisit Perdue. LPA observed (9)nine children supervised by the Licensee and her Assistant. LPA toured the backyard. Licensee demonstrated the pool fence functioning to self latch without assistance. The plan of correction will be cleared as of today's date and the backyard will be placed back on limits.

Exit interview conducted, notice of site visit posted and appeal rights were provided to the Licensee.
SUPERVISOR'S NAME: Maria MayorgaTELEPHONE: (916) 263-1414
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2020
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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