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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622923
Report Date: 10/25/2021
Date Signed: 10/25/2021 02:10:19 PM

Document Has Been Signed on 10/25/2021 02:10 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:CAMPAU, KATHRYNFACILITY NUMBER:
343622923
ADMINISTRATOR:CAMPAU, KATHRYNFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(916) 662-4145
CITY:SACRAMENTOSTATE: CAZIP CODE:
95828
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 8DATE:
10/25/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Kathryn CampauTIME COMPLETED:
02:25 PM
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On 10/25/21, Licensing Program Analyst (LPA) Jan Hoshida conducted an unannounced case management inspection at the facility to inspect an newly installed pool fencing and gate. LPA observed that the see-through mess fencing completely surrounded the pool and is at least five feet high. LPA observed the gate to self-close and self-latch. There are no windows or doors that provide direct access into the pool area. LPA observed that pool fencing meets Title 22 Regulations. Upon arrival, LPA observed that there were eight children, two children were under two years of age, with Licensee's Assistant. Licensee arrived to the facility at 1:45pm.

During the inspection, Licensee requested to put the backyard on-limits. Licensee stated that the two side yards will be off-limits. LPA inspection the backyard and deemed it safe to use as of today.

No deficiency at time of inspection. Exit interview conducted and Notice of Site Visit was issued.
SUPERVISORS NAME: Seychelle De Luca
LICENSING EVALUATOR NAME: Jan Hoshida
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2021
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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