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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619040
Report Date: 04/04/2022
Date Signed: 04/04/2022 10:46:42 AM

Document Has Been Signed on 04/04/2022 10:46 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: 11DATE:
04/04/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Melissa Young, LicenseeTIME COMPLETED:
11:00 AM
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On April 4, 2022, Licensing Program Analyst (LPA) Salene Mayberry, Licensing Program Manager (LPM) Bettina Engelman and Regional Manager (RM) Sharon Ogbodo conducted a case management inspection for the purpose of assessing a bathroom window and access to the pool area.

Licensing staff toured the facility and took measurements to analyze fencing and access to the pool area from both the outside and the inside. Options for making the pool area inaccessible from all sides were discussed with Licensee today. Licensee and licensing staff acknowledge that a further follow-up is needed.

In the areas that were evaluated today, no deficiencies were observed. An exit interview was conducted and notice of Site visit was provided to Licensee to post for 30 days.
SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE: DATE: 04/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/04/2022
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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