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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619207
Report Date: 08/02/2024
Date Signed: 08/02/2024 02:14:47 PM

Document Has Been Signed on 08/02/2024 02:14 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
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BAKER, HALLYFACILITY NUMBER:
343619207
ADMINISTRATOR/
DIRECTOR:		HALLY BAKERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 681-5008
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 11DATE:
08/02/2024
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Hally BakerTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 08/02/24, Licensing Program Analyst (LPA) Jennie Tedlos and Office Technician (OT) Yvonne Flores conducted a Case Management Inspection for the purpose of making an off limit area in the facility on limits. LPA met with Licensee Hally Baker. LPA observed 11 children supervised by Licensee and her assistant.

LPA and Licensee toured the home. LPA was shown Bedroom #2 area that Licensee is requesting to be on limits. The area is a music room that will be used for infant nap time. Current off limit areas of the facility will now be: the garage, bedroom #1, master bedroom, and the right side of the yard with the iron fence.

In the areas that were evaluated today, no deficiencies were observed. An exit interview was conducted and Notice of Site Visit was posted by LPA and must remain posted for 30 days. A failure to comply with posting requirements shall result in an immediate civil penalty of $100.
SUPERVISORS NAME: Karyn Guerra
LICENSING EVALUATOR NAME: Jennie Tedlos
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2024
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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