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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 034500494
Report Date: 04/05/2023
Date Signed: 04/05/2023 06:47:34 PM

Document Has Been Signed on 04/05/2023 06:47 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
SACRAMENTO SOUTH, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:ROSE, MAYFACILITY NUMBER:
034500494
ADMINISTRATOR:ROSE, MAYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(209) 304-0946
CITY:IONESTATE: CAZIP CODE:
95640
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 9DATE:
04/05/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Licensee Rose, May TIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Mariya Melnichuk met with Licensee May Rose for the purpose of a case management inspection. The purpose of today's visit is to change Licensee's Master Bedroom from off limits to on limits. Census at the time of inspection was nine children. Assistant was present during inspection. Licensee's operating hours are Monday through Friday from 6:00 AM. to 6:00 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.

As of today 04/05/2023 the Master Bedroom will be changed to an on limits areas, accessible to children in care. Licensee has requested to make the off limit areas: laundry room, garage, shed, and master bathroom.

LPA toured all areas accessible to children. Toxic and hazardous items are inaccessible to children.

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: Chayntel Hunter
LICENSING EVALUATOR NAME: Mariya Melnichuk
LICENSING EVALUATOR SIGNATURE: DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/05/2023
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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