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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343623540
Report Date: 11/16/2023
Date Signed: 11/16/2023 11:46:16 AM

Document Has Been Signed on 11/16/2023 11:46 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
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:MITCHELL, LISAFACILITY NUMBER:
343623540
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 8CENSUS: 6DATE:
11/16/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lisa MitchellTIME COMPLETED:
12:00 PM
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On Thursday, November 16, 2023 at 11:00 AM, Licensing Program Analyst (LPA) Tanya Washington met with Licensee Lisa Mitchell for an unannounced case management inspection to increase capacity to the maximum number of 14 children and to verify correction of citations issued on 09/27/2023. Upon arrival, LPA observed Licensee and two volunteers providing care and supervision to six children. Everyone residing in the home have obtained the required fingerprint clearance. Facility hours and days of operation are Monday- Thursday from 7:30 AM to 4:30 PM.

Licensee owns the home and control of property has been verified.

On September 29, 2023, Sacramento City Fire Department granted a clearance for a capacity of 14 children.

Off limit areas in the facility consist of: Licensee's daughters bedrooms (bedroom #2 and #3) which are located on the left side of the hallway and both sheds in the backyard. Licensee acknowledged that children may never enter these off-limit areas. Licensee is encouraged to provide 100% supervision at all times. Per licensee, there are no weapons on the premises. Infant safe sleep guidelines were discussed. LPA observed a newly installed netted, large trampoline in the backyard. Licensee was advised to follow manufacturing guidelines for use of trampoline. Licensee was also reminded to keep the trampoline in good repair.

During today's inspection LPA conducted file reviews for children who's files were incomplete or missing during the inspection conducted on 09/27/2023. LPA observed all required information in the children's files.
There are no bodies of water on the premises.
Licensee has recently renewed her CPR and First Aid certification which is now current until 10/14/2025.
Licensee was reminded that if an assistant is left alone with children, they are required to have a current EMSA certified CPR and First Aid certification.

EFFECTIVE TODAY, 11/16/2023 THE FACILITY IS LICENSED TO SERVE A MAX. CAP OF 12 (WHEN THERE IS AN ASSISTANT PRESENT): WITH NO MORE THAN 4 INFANTS.
OR MAX CAP 14 - NO MORE THAN 3 INFANTS. 1 CHILD IN KINDERGARTEN OR ELEMENTARY SCHOOL AND 1 CHILD AT LEAST AGE 6. Notice of site visit posted and appeal rights were provided.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Tanya Washington
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2023
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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