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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573617475
Report Date: 05/12/2022
Date Signed: 05/12/2022 10:48:57 AM


Document Has Been Signed on 05/12/2022 10:48 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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833



FACILITY NAME:THOMAS, ASHLEY N.FACILITY NUMBER:
573617475
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 5DATE:
05/12/2022
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:Ashley Thomas TIME COMPLETED:
10:55 AM
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On May 12, 2022, at approximately 9:30AM Licensing Program Analyst (LPA), Stacey Williams met with Licensee, Ashley Thomas for the purpose of conducting a case management inspection to increase the facility capacity. Licensee applied to change from a Small Family Child Care Home to a Large Family Child Care Home. LPA observed five children present in the home with Licensee and her Assistant. All adults have criminal record clearances.

LPA and Licensee toured the home inside and out. The single-story home has an unfenced front yard, 3 bedrooms, 2 half bathrooms and one full bathroom, den, a living room, kitchen, dining room, and fenced backyard. Off limit areas of the facility will be: all bedrooms, hallway bathroom, garage, and left section of the backyard. Licensee acknowledged that children may never enter the off-limit areas. Licensee stated there are no new residents in the home.

LPA observed A functioning smoke and carbon monoxide detectors and fire extinguisher were observed in the home. The Fire Safety Inspection Clearance has been cleared by Woodland Fire Department on 5/04/22.

REPORT CONTINUED ON SUBSEQUENT PAGE, 809C

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:
DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/12/2022
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, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME: THOMAS, ASHLEY N.
FACILITY NUMBER: 573617475
VISIT DATE: 05/12/2022
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LPA observed that there were no hazardous items accessible to children. Licensee stated that she understands that any poisons must be kept under lock and key. LPA observed that cleaning materials were inaccessible. Licensee stated there are no weapons in the home. Toys appear to be safe. The backyard is fenced.

This facility evaluation report was reviewed and discussed with the Licensee. Records, postings and reporting requirements were discussed. LPA discussed safe sleep regulations and COVID-19 Update Guidance: Childcare Programs and Providers. Licensee was encouraged to visit the department website at WWW.CDSS.CA.GOV for information regarding child care updates, forms, self-assessment guides, regulations and legislation pertaining to family child care homes.

Effective today 5/12/22, facility is approved for a Large Family Child Care License to serve 12 children (when there is an assistant present) with no more than 4 infants, or capacity of 14 children when 1 child is enrolled in Transitional Kindergarten or above and 1 child at least age 6 with a maximum of 3 infants. Without assistant, the ratios revert to those for small family childcare home.

An exit interview was conducted. Facility evaluation report and Notice of Site Visit was provided to Licensee. Notice of Site Visit shall remain posted for 30 days.

SUPERVISOR'S NAME: Bettina EngelmanTELEPHONE: (916) 263-5820
LICENSING EVALUATOR NAME: Stacey WilliamsTELEPHONE: (916) 216-7797
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC809 (FAS) - (06/04)
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