<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 573622056
Report Date: 04/21/2022
Date Signed: 04/21/2022 03:15:12 PM


Document Has Been Signed on 04/21/2022 03:15 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:ESCAMILLA, DONITAFACILITY NUMBER:
573622056
ADMINISTRATOR:ESCAMILLA, DONITAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 921-6498
CITY:WOODLANDSTATE: CAZIP CODE:
95695
CAPACITY:14CENSUS: 8DATE:
04/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Donita EscamillaTIME COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Chayntel Hunter and Lauren Scott met with Licensee Donita Escamilla for the purpose of a case management inspection. The purpose of today's visit is to change daughter's bedroom from off limits to on limits. Census at the time of inspection was eight children. Licensee's operating hours are Monday through Friday from 6 AM. to 6 PM.

All individuals subject to criminal background review have obtained a criminal record clearance. Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

Licensee has requested to make her daughters bedroom on limits. LPAs toured all areas accessible to children. Toxic and hazardous items are inaccessible to children.

As of today 04/21/2022 the daughter's bedroom will be changed to an on limits areas, accessible to children in care. Licensee has requested to make the off limit areas: master bedroom and bathroom, right back bedroom, side yards and 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.
SUPERVISOR'S NAME: Justin L DentonTELEPHONE: (916) -92-0269
LICENSING EVALUATOR NAME: Chayntel HunterTELEPHONE: (916) 917-8620
LICENSING EVALUATOR SIGNATURE:
DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1