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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 393622644
Report Date: 06/12/2020
Date Signed: 06/12/2020 04:47:31 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:BURKS, LETICIA & BURKS JR, RONALDFACILITY NUMBER:
393622644
ADMINISTRATOR:BURKS, LETICIA & RONALDFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 518-5027
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:14CENSUS: 0DATE:
06/12/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Leticia BurksTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Fabiola Diaz conducted a case management tele-inspection via Facetime with licensee, Leticia Burks, due to COVID-19 in lieu of an on-site visit. Inspection took place on 6/12/2020 at 1:30 P.M. During today's tele-inspection, there were 0 children present in care.

Today's tele-inspection was requested to approve the backyard to be used by the children in care. The backyard was inspected via Facetime and was determined to be in compliance with Title 22 regulations. No bodies of water were observed on premises. Licensee stated that the backyard’s fence is secure and safe for the children in care. Licensee stated the fence will be inspected regularly by licensees to ensure it remains safe and secure. The backyard contains a play structure, trampoline, and toys. Licensee stated that the play structure, trampoline, and toys will be in operable and safe conditions at all times. Licensee stated that children in care will be supervised at all times when using the trampoline and play structure. Licensee stated that the trampoline screen can be locked when the trampoline is not in use. LPA advised licensee to follow manufacturer instructions and recommendations.

As of today's date, 6/12/2020, LPA Diaz has approved the backyard to be used by children in care.

An exit interview was conducted. A copy of this report and a Notice of Site Visit was e-mailed to the applicant to keep on file at the facility. A “read receipt” and/or an e-mail from applicant stating applicant has read this report is in lieu of a signature due to COVID-19.
SUPERVISOR'S NAME: Jeanne SmithTELEPHONE: (916) 263-2002
LICENSING EVALUATOR NAME: Fabiola DiazTELEPHONE: (916) 206-9352
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2020
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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