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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343618991
Report Date: 09/20/2022
Date Signed: 09/20/2022 02:22:39 PM

Document Has Been Signed on 09/20/2022 02:22 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:SWANSON, KATHERINEFACILITY NUMBER:
343618991
ADMINISTRATOR:SWANSON, KATHERINEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 214-6028
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 12DATE:
09/20/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Kathrerine SwansonTIME COMPLETED:
02:40 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
On Tuesday, September 20, 2022 at approximately 1:45 pm LPAs Amanda Blesi and Lea Habtom conducted a case management inspection to clear the deficiencies that were cited during the annual inspection on 9.14.22. Upon arrival, LPAs observed five children in care including two infants under age two. At 2:07 pm, 7 school age children and licensee's spouse arrived. LPAs toured the home inside with a focus on previously cited areas. Licensee stated no others are present in the home.

The following deficiencies were cleared during the inspection today:
1. baby walker was removed
2. blankets and stuffed animals were removed from infant sleep area
3. safety latch was repaired on bathroom cabinet
4. lighter fluid and charcoal are inaccessible to children
5. ratios were being followed

LPAs observed signed Acknowledgement of Receipt of Licensing Reports in children's files.

No deficiencies cited during today's inspection.
Notice of site visit provided.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Amanda Blesi
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2022
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