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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619040
Report Date: 02/15/2023
Date Signed: 02/15/2023 12:19:21 PM

Document Has Been Signed on 02/15/2023 12:19 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: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:
02/15/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Melissa YoungTIME COMPLETED:
12:30 PM
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On February 15, 2023, Licensing Program Analyst (LPA) Salene Mayberry met with Licensee, Melissa Young for the purpose of an unannounced plan of correction inspection to clear a capacity citation assessed on 2/7/23.

During today's inspection LPA observed 11 children in care supervised by Licensee and her assistant.

Accordingly, the deficiency cited on 2/7/23 is cleared effective today. A copy of this report and a Proof of Correction letter was provided to Licensee. LPA posted a Notice of Site Visit and Licensee understands it must remain posted for 30 days. 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: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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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