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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 310302689
Report Date: 11/15/2022
Date Signed: 11/15/2022 01:08:18 PM

Document Has Been Signed on 11/15/2022 01:08 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:SIMPSON, GLENNFACILITY NUMBER:
310302689
ADMINISTRATOR:SIMPSON, GLENN/HUNDAL, KULFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 613-3195
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 7DATE:
11/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Glenn SimpsonTIME COMPLETED:
01:30 PM
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On November 15, 2022 Licensing Program Analyst Lea Habtom conducted a case management visit due to the citation given on November 3, 2022. The purpose for today's inspection was to confirm that the licensee, Glenn Simpson, is adhering to the ratio guidelines for a large license and is not caring for no more than 4 infants with an assistant if 12 children are present or 3 infants with an assistant if 14 children are present. The licensee, licensee's spouse and assistant were present in the home during today's inspection. The census for today is 4 infants and 3 preschool children being supervised by licensee and his assistant. There are no Title 22 regulations cited during today's inspection and a notice of site visit was provided to be posted for 30 days.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Lea Habtom
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2022
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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