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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343619232
Report Date: 08/17/2026
Date Signed: 08/17/2026 01:38:38 PM

Document Has Been Signed on 08/17/2026 01:38 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:SOBELMAN, MICHELLEFACILITY NUMBER:
343619232
ADMINISTRATOR/
DIRECTOR:		SOBELMAN, MICHELLEFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 208-0519
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 14TOTAL ENROLLED CHILDREN: 29CENSUS: 9DATE:
08/17/2026
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:20 AM
MET WITH:Michelle SobelmanTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
NARRATIVE
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On 08/17/2026, Licensing Program Analyst (LPA) Jennie Tedlos conducted an unannounced required annual inspection and met with Licensee, Michelle Sobelman. LPA observed 9 children supervised by the Licensee and an Assistant. There was an additional adult resident present. Criminal record clearances have been verified. Facility fees were reviewed and are current. Licensee stated there are no new residents in the home since licensure. Licensee hours of operation are Monday-Friday 7:00 AM-5:30 PM and does not provide overnight care.

Licensee was reminded that all adults 18 and over living or working in the home, including employees and volunteers, except as specified in Health and Safety Code section 1596.871, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day for a maximum of 5 days or, if the penalty is for a repeat violation, for a maximum of 30 days per person will be assessed if this regulation is violated.

LPA conducted a health and safety inspection in all areas accessible to children in care. LPA observed the required facility license and Parent’s Rights postings. Off-Limits Areas include the backyard area with the swimming pool and the entire main home. Off-Limits areas will remain inaccessible to children in care by way of gate, locked or closed doors. Licensee understands that to make any off-limits areas an on-limits area, they must notify licensing and the LPA must do an inspection before children are allowed in the area. The backyard areas are fenced. The backyard has an in-ground pool that is fenced per Title 22 and HSC 1596.814 regulations. LPA observed the gate to swing away from the pool, self-close and self-latch. LPA also observed a labeled United States Coast Guard life ring, a rescue pole with a body hook and minimum fixed length of 12 feet, and a functioning ASTM International Standard F2208 pool alarm. LPA observed a daily inspection log of Licensee’s drowning prevention safety features and safety equipment.

Report continues on 809-C...
Karyn Guerra
Jennie Tedlos
DATE: 08/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SOBELMAN, MICHELLE
FACILITY NUMBER: 343619232
VISIT DATE: 08/17/2026
NARRATIVE
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Toys appear to be safe and in working condition. Poisonous, toxic and hazardous items are observed to be inaccessible to children in care. Cleaning agents and detergents are made inaccessible to children in care. Fire extinguisher, smoke detector, and carbon monoxide detector meet regulation. Licensee states there are no weapons in the home.

LPA conducted record reviews during the inspection. LPA observed a current facility roster and that fire drills are completed and documented at least once every 6 months. Children, Licensee, and Assistants' files were reviewed. LPA did not observe Children's Immunization Records on file and did not observe record of 15 minute sleep checks for infants over12 months of age. Licensee states that infants over 12 months of age are supervised during nap time, however she was unaware that the sleep checks needed to be documented. LPA reviewed Mandated Reporter Training requirements for Assistants. Licensee understands Mandated Reporter Training must be renewed every two years. Licensee’s Mandated Reporter Training expires 08/2026. Mandated reporter training can be accessed at www.mandatedreporterca.com. Licensee has current Pediatric CPR/First Aid certification. Licensee understands Pediatric CPR/First Aid certification must be renewed every two years. Certification expiration date is 09/2027. Pediatric CPR/First Aid training program providers can be found here: https://emsa.ca.gov/childcare_provider/.

Incidental Medical Services (IMS) policy was discussed. For IMS information see PIN 22-02-CCP. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/ (800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: https://www.ada.gov/resources/child-care-centers/.

LPA discussed the safe sleep regulations with Licensee and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed Licensee of the importance of checking for and removing any recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

REPORT CONTINUES ON 809-C...
NAME OF LICENSING PROGRAM MANAGER: Karyn Guerra
NAME OF LICENSING PROGRAM ANALYST: Jennie Tedlos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO S. CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SOBELMAN, MICHELLE
FACILITY NUMBER: 343619232
VISIT DATE: 08/17/2026
NARRATIVE
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Licensee was informed of the MyChildCarePlan.org website; a consumer education website that helps families obtain child care by connecting them to child care providers and Resource and Referral Agencies (R&Rs) throughout California.

During the exit interview, the Licensee Michelle Sobelman, confirmed that there are no Registered Sex Offenders living in the facility, and LPA completed the RSO profile in FAS.

To improve the quality and value of the new inspection process, a survey may be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or CARE tools, please send email inquiries to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process.

In the areas that were evaluated, there were (2) Title-22 Type-B deficiencies regarding Safe Sleep and Immunizations observed and cited, see 809-D page.

A notice of site visit was given and must remain posted for 30 days.
Exit interview conducted and report was reviewed with the Licensee, Michelle Sobelman.
Appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Karyn Guerra
NAME OF LICENSING PROGRAM ANALYST: Jennie Tedlos
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/17/2026 01:38 PM - It Cannot Be Edited


Created By: Jennie Tedlos On 08/17/2026 at 01:18 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: SOBELMAN, MICHELLE
FACILITY NUMBER: 343619232

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
102418(g)
Immunizations
(g) The licensee shall document each child's immunizations as required by the California Code of Regulations, Title 17, Section 6070, and shall maintain such documentation for as long as the child is enrolled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 4/4 children's files which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/18/2026
Plan of Correction
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Licensee will acquire all children's immunization records and place them in their file. Licensee will submit proof of completed immunization records, CDPH 286, to LPA by the POC due date.
Type B
Section Cited
CCR
102425(j)(2)(D)(c)
Infant Safe Sleep
Documentation shall be maintained in the infant’s file and be available to the Department for review. Documentation shall include the following: Time of each 15-minute check

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. Licensee did not document 15 minute sleep checks for infants over 12 months of age which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/18/2026
Plan of Correction
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Licensee will review the provided Safe Sleep Regulations Concepts and sign the packet indicating that it was reviewed. Licensee will send proof of completion to LPA by the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Karyn Guerra
NAME OF LICENSING PROGRAM MANAGER:
Jennie Tedlos
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/17/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2026


LIC809 (FAS) - (06/04)
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