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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573621940
Report Date: 01/28/2020
Date Signed: 01/28/2020 06:56:12 AM

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:GOLAY, ASHLEEFACILITY NUMBER:
573621940
ADMINISTRATOR:GOLAY, ASHLEEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 219-6879
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:14CENSUS: 1DATE:
01/28/2020
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
06:25 AM
MET WITH:Licensee, Ahlee Golay-SanchezTIME COMPLETED:
07:05 AM
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Licensing Program Analyst (LPA) Chayntel Hunter met with Licensee Ashlee Golay-Sanchez for the purpose of a case management inspection. The purpose of today's visit is to change Licensee's master bedroom and bathroom 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 Licensee's own child. Licensee's operating hours are Monday through Friday from 7:00 AM. to 5:30 PM.

Licensee is having construction done in the kitchen. Licensee has requested to make the master bedroom and bathroom an on limits area while construction is happening. LPA toured all areas accessible to children. Toxic and hazardous items are inaccessible to children. LPA will conduct a follow up inspection when construction is complete.

As of today 01/28/20 the master bedroom and bathroom will be changed to on limits areas, accessible to children in care. Licensee has requested to make the off limit areas: the kitchen, backyard, library, last bedroom, laundry room, dog run and garage.

This facility evaluation report was reviewed and discussed with Licensee. A Notice of Site Visit was provided and should remain posted for 30 days for parental review. 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: 01/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2020
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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