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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619040
Report Date: 02/10/2022
Date Signed: 02/10/2022 09:48:39 AM

Document Has Been Signed on 02/10/2022 09:48 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
CCLD Regional Office, 2525 NATOMAS PARK DR. STE 250
SACRAMENTO, CA 95833
FACILITY NAME:YOUNG, MELISSAFACILITY NUMBER:
343619040
ADMINISTRATOR:YOUNG, MELISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 212-9649
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 14DATE:
02/10/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Melissa YoungTIME COMPLETED:
10:00 AM
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On 2/10/22 at 8:45 AM Licensing Program Analysts (LPAs) Christopher Jackson and Salene Mayberry met with licensee Melissa Young. The purpose of today's inspection is to conduct a follow up case management inspection regarding a capacity citation assessed on 2/1/22. Today LPA's observed 14 children in care supervised by licensee and her assistant. However, during today's inspection none of the children in care were Six years of age or above. The deficiency cited on 2/1/22 cannot be cleared today. Civil penalties of $800 were assessed today. During the inspection two children left during placing the facility in compliance.
SUPERVISORS NAME: Justin L Denton
LICENSING EVALUATOR NAME: Christopher Jackson
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2022
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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