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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573621619
Report Date: 01/04/2022
Date Signed: 01/04/2022 12:43:17 PM

Document Has Been Signed on 01/04/2022 12:43 PM - 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:WILLIAMS, LADONNAFACILITY NUMBER:
573621619
ADMINISTRATOR:WILLIAMS, LADONNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 917-5019
CITY:WEST SACRAMENTOSTATE: CAZIP CODE:
95691
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 10DATE:
01/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Licensee, Ladonna WilliamsTIME COMPLETED:
12:50 PM
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Licensing Program Analysts (LPAs) Chayntel Hunter and Lauren Scott met with Licensee Ladonna Williams for the purpose of a case management inspection. The purpose of today's visit is to change Licensee's backyard from off limits to on limits. All individuals subject to criminal background review have obtained a criminal record clearance. Census at the time of inspection was ten children.

Licensee has installed an in ground pool in the backyard. LPAs toured the backyard and inspected the pool. The in-ground pool area is fenced per Title 22 regulations and LPAs observed the gate to self-close and self-latch. There are locked windows or doors that provide direct access into the pool area. LPAs discussed supervision regarding pools.

As of today 01/04/2022 the backyard will be changed to an on limits areas, accessible to children in care. Licensee has requested to make the off limit areas: 3 BEDROOMS UPSTAIRS, LAUNDRY ROOM & GARAGE.

This facility evaluation report was reviewed and discussed with Licensee. A notice of site visit was provided and must remain posted for 30 days. Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

In the areas that were evaluated, no deficiencies were cited during today’s inspection.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Chayntel Hunter
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2022
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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