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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619040
Report Date: 05/17/2022
Date Signed: 05/17/2022 10:17:26 AM

Document Has Been Signed on 05/17/2022 10:17 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: 13DATE:
05/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Melissa YoungTIME COMPLETED:
10:25 AM
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On May 17, 2022, Licensing Program Analyst (LPA) Salene Mayberry and Licensing Program Manager (LPM) Bettina Engleman conducted a case management inspection for the purpose of ensuring the fencing surrounding the above ground pool meets all Title 22 Regulations.

During the inspection, Licensing Staff observed a white metal fence that was at least five feet high and constructed so the fence is not obscuring the pool from view. Licensing Staff also observed that the pool gate swings away from the pool, is self-closing and self-latching. In addition, LPA Mayberry walked down the fence line and pulled on the fence to observe the sturdiness. The fence extends all the way to the shed. There is an additional fence installed between the shed and the wooden perimeter fence, making the entire pool area inaccessible from all sides of the yard.

In the areas that were evaluated today, no deficiencies were observed. An exit interview was conducted with Licensee and LPA Mayberry posted a Notice of Site visit which must remain posted for 30 days. Licensee understands that a failure to comply with posting requirements shall result in an immediate civil penalty of $100.

SUPERVISORS NAME: Bettina Engelman
LICENSING EVALUATOR NAME: Salene Mayberry
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2022
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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