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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573607438
Report Date: 12/23/2019
Date Signed: 12/23/2019 01:50:06 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:GEE, DOROTHEA & CABALTERA, ELIZAFACILITY NUMBER:
573607438
ADMINISTRATOR:GEE,DOROTHEA&CABALTERA,ELIFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 662-5667
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:14CENSUS: 9DATE:
12/23/2019
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Licensees, Dorothea Gee and Eliza CabalteraTIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Chayntel Hunter and Christopher Jackson met with Licensees, Dorothea Gee and Eliza Cabaltera for the purpose of an unannounced annual continnuation inspection. Present was also the Licensees' two assistants and the husband of one of the Licensees. All individuals subject to criminal background review have obtained a criminal record clearance. Census at the time of inspection was 9 children.

LPAs conducted a continuation of the annual inspection originally conducted on 11/22/19. During today's inspection, LPAs conducted interviews with both clients in care and staff. LPAs previously assessed Technical Violations (TVs) and LPAs were following up to ensure that facility remains in compliance. LPAs observed that a fire drill had been conducted and documented. LPAs reviewed staff personnel files and observed forms in the file. LPAs reviewed children's files and observed required documentation in the children's files.

This facility evaluation report was reviewed and discussed with Licensees. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. Licensees were encouraged to visit the Department website at WWW.CCLD.CA.GOV for child care updates, current forms, legislation and regulation information. A copy of this report will remain on file for a period of three years for public review upon request. Licensee's signature on this form acknowledges receipt of this form.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.
SUPERVISOR'S NAME: Sharon OgbodoTELEPHONE: (916) 263-5721
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2019
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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