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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585406657
Report Date: 10/22/2021
Date Signed: 10/22/2021 10:34:36 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:AUST, SHAWNA FAMILY CHILD CARE HOMEFACILITY NUMBER:
585406657
ADMINISTRATOR:AUST, SHAWNAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 741-2344
CITY:PLUMAS LAKESTATE: CAZIP CODE:
95961
CAPACITY:14CENSUS: DATE:
10/22/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Shawna AustTIME COMPLETED:
10:45 AM
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A case management inspection was conducted at the facility by Licensing Program Analyst (LPA) Kirk Marks. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. The inspection was done at the request of licensee. The licensee has installed an in-ground pool in the back yard, which is in the play area for children in care. During today’s visit the home and grounds were toured and the licensee was operating within the licensed capacity, with an adult assistant present. There were 12 children in care, none of which are infants. The pool is surrounded by a five foot Guardian pool fence that meets requirements. There are two gates which are both self closing, self latching and swings away from the pool. During today's inspection all children were inside the home with the licensee and assistant. LPA took photos of the pool and fence for the facility's files The licensee agreed to submit a new yard facility sketch showing the pool addition. The pool and fencing has been approved by LPA for children to be present in the back yard for outdoor play. All licensing reports are public information must be made available upon request for at least three years.
Notice of Site Visit shall be posted for 30 days from today's visit.

There were no Title 22 deficiencies cited during today's visit.

SUPERVISOR'S NAME: Megan AvilesTELEPHONE: (530) 895-5984
LICENSING EVALUATOR NAME: Kirk MarksTELEPHONE: (530) 895-5045
LICENSING EVALUATOR SIGNATURE:

DATE: 10/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2021
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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