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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 503607005
Report Date: 06/17/2020
Date Signed: 06/17/2020 04:19:42 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:BUTCHER, TRACIFACILITY NUMBER:
503607005
ADMINISTRATOR:BUTCHER, TRACIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 521-6067
CITY:MODESTOSTATE: CAZIP CODE:
95358
CAPACITY:14CENSUS: 0DATE:
06/17/2020
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Traci ButcherTIME COMPLETED:
02:30 PM
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On 06/17/2020, Licensing Program Analyst (LPA) Angelica Mejia, conducted a Licensee initiated case management tele-inspection. Due to COVID-19 and the suspension of in-person visits, LPA conducted a tele-inspection with Licensee Traci Butcher via Google Duo. The purpose of today's tele-inspection was to inspect an above ground pool that Licensee recently installed in her backyard.

Licensee stated the pool will be used for Licensee's personal use only and will be off-limits for day care children and during day care operating hours when children are present. The pool is round and has a regulation approved heavy-duty plastic fence mounted on top of the pool. The barrier completely surrounds the pool from the rim of the pool extending upwards, totaling 5 feet 5 inches of measurable barrier, which includes the pool structure. The fencing is permanently attached to the pool frame with screws. Vertical spacing between the fence bars did not allow the passage of a four-inch diameter ball as demonstrated by Licensee during the tele-inspection. Horizontal spacing between the pool and the base of the pool fence does not exceed three inches at the widest point.

The pool gate opens away from the pool and is self-closing and self-latching. The latch is located within the top 6 inches of the pool gate. The pool is accessed via a pool ladder placed at the pool gate opening and is removable when not in use. Licensee understands that the ladder is to be removed when not in use and made inaccessible to daycare children. During the tele-inspection, LPA observed the ladder in an area of the yard made inaccessible to children by sturdy plastic lattice fencing. LPA observed a pool cover over the pool which Licensee stated will be placed on the pool when it is not in use. The pool pump and hoses are made inaccessible by a sturdy plastic lattice fence surrounding the equipment and attached to the pool structure at each end. Pool chemicals and supplies are stored in a locked storage container located on the side of the house in the backyard. Licensee provided LPA with an updated Facility Sketch (LIC 999) which includes the new pool.
(Continued on LIC809-C)
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Angelica MejiaTELEPHONE: (559) 341-6126
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2020
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME: BUTCHER, TRACI
FACILITY NUMBER: 503607005
VISIT DATE: 06/17/2020
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The pool and surrounding fence were inspected and approved.

Per Title 22, Division 12, Chapter 3, of the California Code of Regulations, no deficiencies were cited.

An exit interview was conducted with Licensee, during which this report was discussed. A copy of this report and appeal rights were provided via email. Licensee will send a copy of the report signed with her original signature to the Fresno Regional Office.
SUPERVISOR'S NAME: Duane MatsubaraTELEPHONE: (559) 650-7855
LICENSING EVALUATOR NAME: Angelica MejiaTELEPHONE: (559) 341-6126
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2020
LIC809 (FAS) - (06/04)
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