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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313622857
Report Date: 10/22/2024
Date Signed: 10/22/2024 08:21:46 AM

Document Has Been Signed on 10/22/2024 08:21 AM - 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 CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:VAUGHAN, DOLLYFACILITY NUMBER:
313622857
ADMINISTRATOR/
DIRECTOR:		VAUGHAN, DOLLYFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 275-6230
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
10/22/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:00 AM
MET WITH:Dolly and Thomas Vaughn-Licensee and
husband		TIME VISIT/
INSPECTION COMPLETED:
08:30 AM
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LPA made an unannounced case management inspection to the home and met with licensee and her husband. The purpose of the inspection was to observe a newly added spa to the back yard. Present at time of inspection were licensee, her husband and 6 day care children.

LPA Owens observed a covered and locked spa in the back yard behind a door that locks and a gate. The spa is inaccessible to children and is located in an off limit area in the back yard.

LPA Owens did not observe any hazards or deficiencies at time of inspection.
SUPERVISORS NAME: Jennifer Brekke
LICENSING EVALUATOR NAME: Katrina Owens
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
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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