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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 535407082
Report Date: 09/16/2021
Date Signed: 09/17/2021 09:14:36 AM

Document Has Been Signed on 09/17/2021 09:14 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:BAUMAN, KAELYN FAMILY CHILD CARE HOMEFACILITY NUMBER:
535407082
ADMINISTRATOR:BAUMAN, KAELYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 739-9529
CITY:WEAVERVILLESTATE: CAZIP CODE:
96093
CAPACITY: 14TOTAL ENROLLED CHILDREN: 0CENSUS: 4DATE:
09/16/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Kaelyn BaumanTIME COMPLETED:
10:10 AM
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A Case Management visit was conducted on 9/16/21, by Licensing Program Analyst, Wisehart who met with the licensee after she requested a visit for a new pool on the property. The LPA toured the facility inside and outside.

The licensee installed an above ground pool which is fenced with a fence that is at least 5 feet high once attached to the side of the pool; the fence completely surrounds the pool and the pool view is not obscured by the fence. The fence has a gate that self closes/latches and it swings away from the pool. The self latching device is no more then 6 inches from the top of the gate. The licensee understand that constant supervision is required when children are outside. The LPA also provide the current COVID PIN 21-18 and Guidance.

No title 22 deficiencies were cited during this visit.

Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISORS NAME: Megan Aviles
LICENSING EVALUATOR NAME: Carrie Wisehart
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2021
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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